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  • DEPARTMENT OF POST GRADUATE STUDIES IN SWASTHAVRITTA SHRI DHARMASTHALA MANJUNATHESHWARA COLLEGE OF AYURVEDA & HOSPITAL HASSAN - 573 201. Certificate This is to certify that the thesis entitled “EFFECT OFUDVARTHANA IN STHOULYA” is the record of research workconducted by ‘PRASANNA KUMAR K’ under my direct supervision andguidance as a partial fulfillment for the award of the degree of M.D.(Ayu)in Swasthavritta. Some of the observations made in this elaborative clinicalstudy are original and have definitely contributed in the advancement of theexisting knowledge of the subject. The candidate has fulfilled all the requirement of ordinanceslaid down in the prospectus of Rajiv Gandhi University of Health Sciences,Bangalore, Karnataka for the award of Degree of Doctor of Medicine(Ayu.) Swasthavritta. I am fully satisfied with his work and recommend this thesis tobe submitted for adjudication.Guide HODDr. Sajitha.K M.D.(Ay) Prof. Ramana. G.V M.D (Ay).Asst. Prof. Prof. & HODDept. of PG studies in Swasthavritta Dept. of PG studies in SwasthavrittaSDM College of Ayurveda & Hospital SDM College of Ayurveda & HospitalHASSAN. HASSAN.Date: 28-03-04Place: HASSAN
  • CONTENTSI. Introduction 1-4II. Literary review 1. Sthoulya 5-32 a. Paribhasha 6 b. Historical Background 7-9 c. Physiological consideration of Meda Dhatu 10-11 d. Nidana 12-16 e. Samprapthi 17-21 f. Poorvaroopa 22 g. Roopa 23-25 h. Upadrava 26-27 i. Sadhyasadhyata 28 j. Chikitsa 29-33 2. Obesity a. Lipids 34-41 b. Definition 42-43 c. Etio-Pathogenesis 44-50 d. Assessment 51-54 e. Morbidity- Mortality 55 f. Complication 55 g. Treatment 56-59
  • 3. Udvartana h. Paribhasha 60 i. Concept of Rookshana 61-63 j. Historical Background 64 k. Classification 65 l. Benefits 66 m. Procedure and mode of Action (rubbing) 67-70 III. Clinical study a. Study design 71 b. Reason for selecting Study Design 72 c. Objectives of Study 74 d. Selection criteria 74 e. Objective Parameters 75 f. Subjective Parameters 75-78 g. Drug Review 79-80 i. Treatment Procedure 81-82 IV. Observation and Results 83-109 V. Discussion 110-124 VI. Summary and Conclusion 125-129 VII. List of Reference 130-131 VIII. Bibliography 132-133 IX. Annexure I-XIV
  • Acknowledgement Acknowledgement I offer my prayers to Lord Aanjaneya and Sri Raghavendra Swamijiwho gave me strength to overcome all the difficulties during this Thesis work. I bow my head on the foot of Dr. Virendra Hegdeji, the founderpresident of SDMCA, Hassan for his endless service to society. I am very much thankful to Prof. Prasanna .N. Rao, Principal, whoprovided the necessary facilities for the completion of this work. I express my sincere gratitude to most honourable and esteemed teachersDr. Ramana.G.V, HOD and Dr. Sajitha .K, Guide, for their unforgettableparental affection and patience cooperation to give suggestions at every step inaccomplishing the present work. My most respects and indebtedness to Dr. Sekhar, Dr. Bhaskar Rao,Dr. Mallika, Dr. Muralidhar Pujar, Dr. Prasanna Kerur, Dr. Sanjay Dasand Statistician Dr. Mahadevappa for their valuable suggestions. I take this opportunity to thank Prof. B.G. Gopinath, Dr. B. SrinivasPrasad, Dr.Chandrashekar, Dr. Prakash Mangalasseri Dr. kishorePatwardan and Dr. Kiran Gowda who taught me the science and arts ofmedicine. My vocabulary falls short of suitable words to express my deep sense ofgratitude to my friends Dr. Sairam, Dr. Krishna, Dr. Sudheer and Dr. Suhasfor their timely support and brotherly care. I am greatfull to Dr. Manjunath N.S, Dr. Guruprasad. K andDr.Vijaya Lakshmi for their constant help. It is a privilege for me to express my thanks to Dr.Srinibash Sahoo,Dr.AshwinKumar, Dr.Raju, Dr.Prasanna Aithal, Dr.Ashwini MJ,Dr.Gururaj, Dr.Srinivas GK, Dr.Amit Deshmukh, Dr.Vijay Biradar,Dr.Gopikrishna, Dr.Dheeraj, , Dr.VishalAgarwal, and Dr.Manjunath NP. I express my best wishes to Dr. Sudheendra, Dr. Shivakumar,Dr.Guhesh, Dr. Monilal, Dr. Srikanth, Dr. Adithi, Dr. Manish and Dr.Uday. Effect of Udvarthana in Sthoulya
  • Acknowledgement I am thankful to internees Raghavendra, Poornima, Sudarani,Shivananda, Nalina and Usha who helped me for survey work. It was not possible to complete this work without Patients therefore I amvery much greatfull to each and every patient who cooperated me for this work. I fail in my duty if I don’t recall Dr. Srikanth PL, Dr. Madhav Diggavi,Dr. Srinivas T, Dr. Vishala, Dr. Anupama, Dr. Gurubasavaraj and Shobhafor their inspiration to join MD. I take this opportunity to thank whole heartedly to Mr.Raghavendrachar.B and Mr.Ramachandra who helped me for getting MDseat. This work has not been completed if Mr. Venugopal K andMr.Venugopalachar had not supported and blessed me. I am greatfull to Smt.Shantha bai- my grand maa, Smt.Shashikala, Sri.Muralidhar Rao,Smt.Chayya Kulkarni, Smt.Sudha shyati and Sri Eranna Pathrimath fortheir encouragement and blessings. This world of words failed to provide me a word just capable ofexpressing my feelings to my friend late Preethi for her long-lasting inspiration. I heartly acknowledge my love and affection to my brother Praveen,sisters Poornima and Pallavi, Mr. Satish and my sweet Shreya. On this occasion with a great reverence I humbly offer my pranamas atthe lotus feet of my mother Smt. Rekha Kulkarni and father Sri. K. SatyaPrakash, who have shaped me into what I am today. All the credit of this workgoes to them. May Lord Dhanwanthri bless all with Hitayu and Sukhayu who helpedme directly and indirectly in completing this work. Prasanna Kumar K Effect of Udvarthana in Sthoulya
  • List of TablesTable Content Page Paryaya of Sthoulya 062 Direct Aharatmaka Nidana 143 Indirect Aharatmaka Nidana 154 Viharatmaka Nidana 155 Manasika Nidana 156 Anya Nidana 167 Important Nidana with its features 168 Sthoulya Lakshana 259 Sthoulya Upadrava 2710 Ahararupi Pathya – Apathya 3211 Vihararupi Pathya – Apathya 3312 Different constituents of lipoprotein 3613 Normal limits of blood cholesterol 3914 Distribution of adipose tissue. 4015 Role of different genes 4616 Interpretation of BMI 5217 Drugs, there mode of action and adverse effects 5818 Difference between Langhana and Rookshana 6019 Effects of Rookshana karma: 6120 Samyak Rookshana Lakshana 6121 Rookshana athi yoga lakshana 6122 Rookshana Ayoga Lakshana 6323 Benefits of Udvarthana 6624 Sthoulya cases as per Age-wise Distribution 8325 Sthoulya cases as per Sex wise distribution 8326 Sthoulya cases according to their Religion 8427 Sthoulya cases according to their Socio-economical status 8428 Sthoulya cases according to their occupation 8429 Sthoulya cases according to their Prakruthi 8430 Sthoulya cases according to chronicity of disease 8531 Sthoulya cases according to Family history 8532 Sthoulya cases according to quantity of food consumption 8533 Sthoulya cases according to frequency of food consumption 8634 Sthoulya cases according to their Pana 8635 Sthoulya cases according to Rasa preferred 8636 Sthoulya cases according to Nidra kala 8637 Sthoulya cases according to their Adhyatana Agni 8738 Sthoulya cases according to their Poorvagni 8739 Sthoulya cases according to their Abhyahvarana shakthi 8740 Sthoulya cases according to their Jarana shakthi 8741 Sthoulya cases according to their Jatha Desha 8842 Sthoulya cases according to their Samvrudha Desha 8843 Sthoulya cases according to their Vyadhitha Desha 88 Effect of Udvarthana in Sthoulya
  • Cont…Table no. Content Page no.44 Sthoulya cases- Body frame 8945 Sthoulya cases- Educational status 8946 Sthoulya cases as their per Associated Features 8947 Sthoulya cases as per their Vihara 9048 Changes in chala spik, sthana and udara lambana 9049 Changes Ayathaupachaya utsaha hani 9050 Changes in Swedadhikyata 9151 Changes in Ayase Swasa 9152 Changes in Nidradhikya 9153 Changes in Adhika Kshuda 9254 Changes in Ahara matra 9255 Changes in Ahara kala 9256 Changes in Athi Pipasa 9357 Changes in Kshuda sahatva 9358 Changes in kshuda souhitya 9359 Changes in Alpa vyayama 9460 Changes in Anga gourava 9461 Changes in Anga sithilatha 9462 Changes in Gatra sada 9563 Statistical analysis of Subjective assessment 9564 Changes in weight 9765 Response in weight 9766 Changes in BMI 9867 Response in BMI 9868 Statistical analysis of changes in weight and BMI 9969 Response in chest circumference 10070 Response in abdomen circumference 10071 Response in hip circumference 10072 Response in Mid-arm circumference 10173 Response in Mid-thigh circumference 10174 Statistical analysis of Circumference of Chest, 102 Abdomen, Hip, Mid-arm, Mid-thigh75 Decrease in Total cholesterol level 10276 Changes in Total cholesterol 10377 Changes in HDL 10378 Increase of HDL level 10479 Changes in LDL 10480 Decrease of LDL level 10581 Changes in Triglycerides 10582 Decrease of Triglycerides level 10683 Statistical analysis lipid profile 106 Effect of Udvarthana in Sthoulya
  • Contd..Table Content Page Age wise distribution of survey patients 10785 Sex wise distribution of survey patients 10786 Religion wise distribution of survey patients 10787 Nature of work wise distribution of survey patients 10888 Diet wise distribution of survey patients 10889 Height wise distribution of survey patients 10890 Weight wise distribution of survey patients 10991 B.M.I wise distribution of survey patients 10992 Synonym of Sthoulya with modern interpretation 11093 Common Indian preparation with kcal.of energy IX94 Activities and caloric burn for different weight X95 Recommended energy intake for age, height, & weight X96 Height and weight for women of different ages XI97 Height and weight for men of different ages XI98 Common Indian cereals with their nutritive value XII99 Common Indian vegetables with nutritive value XII100 Miscellaneous Indian foodstuff with nutritive value XIII101 Reducing and weight maintenance diet of high cost XIII102 Reducing & weight maintenance diet of medium cost XIV103 Reducing and weight maintenance diet of low cost XIV Effect of Udvarthana in Sthoulya
  • Abbreviations Abbreviations(1) Cha. sam - Charaka samhita(2) Su. sam - Sushruta samhita(3) As. San - Astanga sangraha(4) As.Hr. - Astanga hridayam(5) Sha. sam. - Sharangadhara samhita(6) Bh.Pr. - Bhava Prakasha(7) Ma.Ni. - Madava Nidana(8) Yo.Ra. - Yogarathnakara(9) Ka. san - Kashapa samhita(10) Ra. vai - Rasa vaisheshika(11) su - Sutrasthana(12) vi. - Vimanasthana(13) sha - Shareera(14) ni - Nidanasthana(15) si. - Siddisthana sthana(16) chi. - Chikitsasthana(17) khila - Khilasthana(18) Ut. - Uttarasthana(19) BT - Before treatment(20) AT - After treatment(21) Dif. - Difference Effect of Udvarthana in Sthoulya
  • Introduction Scientific and technological progress has made man highly sensitive andcritical; there by giving rise to different types of health problems. Theadvancement of industrialization and communication is contributing towardssedentary life styles, in turn causing chronic non- communicable diseases likediabetes mellitus, hypertension, cancer, ischemic heart disease, cerebro-vascularaccidents, atherosclerosis, varicose veins etc. Obesity being the risk factor forthese diseases and hence prevention of obesity will decrease the chances of suchdiseases. Excess of fat is a disadvantage rather then an asset; it may “lengthenthe waist line” but “shortens the life line” of the individual by imposing an extraburden on all the systems of body. Inspite of advanced technology and researches, the modern medicine isfailing to give the best result for obesity, due to its multifactorial nature. Likeother diseases, obesity is mostly the result of factors like heredity, environmentor food, but it is difficult to decide the involvement of prime factor. It is notpossible to change heredity; it is difficult to change environment, but relativelyeasy to change food habits and life styles. Hence intervention at this level is need 1of the hour. Obesity is a major health problem in both developed and developingcountries. The exact estimation of prevalence is difficult as the standardizeddefinition is lacking. In countries like USA, approximately 55% of population inthe age group of 20-70 years is suffering from this problem. A study conductedin Delhi shown that approximately 25% of populations are obese in urban areas.Another study conducted in United States, showed increase in sudden death rateamong men and women with at least 20% overweight, which clearly shows thereduced life span due to its incidence. Ayurveda, the science of life, had given much importance to primary andsecondary preventions of diseases. Acharya’s have explained at length thevarious procedures that are to be implemented under Dinacharya and Ritucharya.These are advocated under a branch – Swasthavritta, which explains theprevention of diseases at different levels. The procedures like Abhyanga,vyayama, Udvarthana are explained in Dinacharya with an aim of maintaining Effect of Udvarthana in Sthoulya
  • Introductionone’s own physique in moderation. In Dasha vidha pareeksha, samhananapareeksha is to be examined to determine the compactness of dhatu i.e. the frameof the body, which is essential in the treatment context. Sthoulya is the nearest clinical entity for obesity in Ayurveda. Forcausation of Sthoulya, excessive intake of calories with a decreased expenditureis the main reason. With a view of preventing excessive consumption, only twoAnnakala are specified with intermediate period of 8-10 hours. While decidingthe Ahara to a person, the 8 factors (Ashta vidha Ahara Vishesha ayathana) areprescribed which includes the assessment of quantity, quality and composition.These eight principles incorporate all the modern parameters described in thecontext of nutrition. Considering the difficult nature of disease, obesity can bebetter prevented rather than treated. In ayurveda, obese persons are includedunder Asta Nindita purusha (Athi Deerga, Athi Hraswa, Athi Stoola, AthiKrusha, Athi Goura, Athi Sweta, Athi Roma and Aroma). The reason fordifficult nature being the involvement of Tridosha and affliction of sapta dhatu.It is also mentioned that the preferred constitution for an individual should be 2emaciated rather than obese. The existing obesity treatment options, in modern medicine includesdrugs like Fenfluramine, Dexfenfluramine and Sibutramine which acts asappetite inhibitors have with of adverse effects and cannot be used for more thanthree months. The diuretic and purgatives drugs are also used to treat obesity,but the action is for shorter term, and the patients again put on weight aftercessation of treatment. Some devices like vibrators are being used for locallipolytic action. Nutritional combinations (synthetic nutritional compounds) areexpensive and they too have untoward effects.In the present context Ayurveda offers a ray of hope in treatments like lekhanabasti, virechana, Udvarthana along with some internal medicines like Navakaguggulu, trayodashanga guggulu etc. The periodical Shodhana has also provenits efficacy. Among these therapies, the internal administration of guggulu hascertain limitations like gastric irritation, constipation etc. The administration oflekhana basti is to be undertaken for prolonged period and administration of Effect of Udvarthana in Sthoulya
  • Introductionwhich requires medical supervision. On contrary, Udvarthana is a procedurewhich can be undertaken daily with a preliminary training to the individual. It’sefficacy has been proved in reduction of Hyperlipidemia in the earlier studies;but its efficacy in reducing body weight has not yet studied. The observation atour hospital-conducted studies on the same over considerable samples showssignificant reduction in body weight in a very short duration of time with noadverse effects. Before and after Udvarthana, purgation was given. To document and analyze this procedure for statistical interpretation, thestudy entitled “ Effect of Udvarthana in Sthoulya” was undertaken. The effect ofUdvarthana in reducing weight and its relationship with serum lipid values wasalso considered. The whole dissertation consists of three studies under the followingheadings.  Conceptual study  Clinical study and 3  Survey studyConceptual study This part of the study deals with the literary review of sthoulya asexplained in classics with spatial reference to its Paribhasha, Nirukti, Historicalbackground, Nidana panchaka and Chikitsa etc. In further, the concept of obesity is explained considering from lipids toetymology, etiopathogenisis and treatment etc. No correlation was made inbetween and so that it can be interpreted in discussion chapter. The last part of this conceptual study includes the review of Udvarthana.It includes the Nirukthi, Paribhasha, etc of Udvarthana. For better understandingof this procedure, the principles of Rookshana are considered, as it is one amongthe Rookshana karma. Hence Rookshana is also explained in brief givingimportance for its practical approach. Effect of Udvarthana in Sthoulya
  • Introduction Clinical study This part of the study deals with the materials and methods. The methodsinclude the study design, reason for selecting design, objectives, selectioncriteria, subjective and objective parameters for assessments. The materials include the drug review, method of preparation ofUdvarthana dravya, procedure etc.Survey study As exact incidence and prevalence rates of obesity are not available, anattempt is made to survey the patients attending the OPD to assess the incidencerate. The study was carried out for thirty working days.All the observations, data and results are tabulated in the observations andresults section along with pictorial presentation. Based on the conceptual studyand results, a critical analysis was made in discussion part. In this chapter rightfrom the review of literature to clinical and survey study, discussions are carriedout. It also includes the probable mode of action of Udvarthana on sthoulya and 4also on lipid profile.In conclusion and summary chapter the dissertation is concluded. Here the wholeof the work is sum up with few important outcomes. Last but not least this dissertation include bibliography and appendixwhere some of the tables which are important for clinical study are enclosed,which includes case sheet, master chart, diet chart etc, helping the reader toverify the things wherever required. Effect of Udvarthana in Sthoulya
  • Review of literature-Sthoulya Sthoulya Paribhasha The word “Sthoola” is derived from root “Sthu” with suffix “ach” whichstands probably for “Thick” or “Solid” or “Strong” or “Big” or “Bulky”. Thedifferent meanings denoted by various Granthakara’s can be summarized asbelow- Shtulasya bhavam Sthoulyam – vachaspathyam (6/358) Sthulayathi te cha athaha Sthoulyam- vachaspathyam (6/358) Sthula paribhrane- Amarakosha (Nanartha varga 204) Sthulayathi Sthula Brumhane ach- Hemachandra Sthula sthiryate barhi asmavat- Bruhaspathi 5 Sanchaya Pravachana madhyam trike Sthulatha- Koutilya (patala 1/10) Medini opines Sthoola as “koota” or “samuha” which means the cluster.The human with large frame is known as “Sthoola” and “Sthoulya” is anadjective of the word “Sthoola”. Dictionaries give the meaning of “Sthoola” as: Large  Great Bulky Huge Fat Corpulent The word “Sthoola” is also used as synonym for some drugs like Khanda,Priyangu, Rakta lashuna, Ikshu etc. Effect of Udvarthana in Sthoulya
  • Review of literature-Sthoulya Sthoulya Nirukthi Different scholars had given their contribution in defining Sthoulya.Among them are:  A person having heaviness and bulkiness of the body due to extensive growth especially in Udaradi region is termed as “Sthoola” and this state (Bhava) of Sthoola is called as “Sthoulya”1.  Athi Sthoola has been defined as a person who on account of the inordinate increase of fat and flesh is distinguished with pendulous buttocks, belly and breasts and whose increased bulk is not matched by a corresponding increase in energy2. Sthoulya Paryaya Table no.01 showing Paryaya of Sthoulya as per different texts: 6Sl. Paryaya Ch. Su. As. Ka. Ma. Sha Bh. Yo.No Sam Sam San Sam Ni Sam Pra Ra1 Sthoulya + + + + - - + +2 Athi Sthoulya + + + - - - + +3 Sthoolata - + + - - - - -4 Sthoolatwa - - + - - - - -5 Sthavima - - + - - - - -6 MedoRoga - + + - + + + +7 MedoDosha + - - - - + + +8 Medovriddhi - - - - - - + +9 Medovikara - - - - - - + -10 Medogada - - - - - + + -11 Medopushti - - - - - - - +12 Medadushti - - - - - - - +13 Athipushti - - + - - - + -14 Pushti + + + + - + + +15 Upachaya + + + + - + + +16 Jathasya - + - - - - - -17 Brumhana + - + + - - - -18 Medaswita - - - - - - - +19 Medurata - - - - - - - + Effect of Udvarthana in Sthoulya
  • Review of literature-Sthoulya Historical backgroundI) Reference in Vedas: Ayurveda is known to be upaveda of Artharvana Veda. We find somescattered reference of sthoulya in this Veda like:“Pivasi ……. Naiva Majja svahatam” | 1/11/4MEDASI :“ye kilaarlana tarpayanthi ye dhatena ye va kyo Medasicha si mam”| 4/27/5II) Reference in samhita:a. Brihatrayi; In the big triads of Ayurveda i.e. Charaka samhita, Sushrutha samhita andAstanga sangraha, we find many reference regarding sthoulya.1.Charaka Samhita Acharya Agnivesha has explained sthoulya under the heading of Ashta 7Nindita in Sutra Sthana 21st chapter. Here the descriptions of Etiology,pathogenesis, symptomatology, along with its treatment and diet have beenexplained. Athi sthoulya is also mentioned as one of the Kaphaja Nanatmajavikara.2. Sushrutha Samhita In Sutrasthana 15th chapter “Dosha Dhatu Mala Vignana” the descriptionof sthoulya has been explained which includes causes, symptoms, signs andtreatment. In Sutra sthana 35th chapter the treatment principles of sthoulya hasbeen explained3. 3. Ashtanga Sangraha It has been described the different aspects of sthoulya in Sutrasthana “Dwividhopakramaniya” chapter. It is also explained that sthoulya is “Athi Brumhanajanya” Vyadhi. Effect of Udvarthana in Sthoulya
  • Review of literature-Sthoulya b. Laghutrayi 1. Madhava Nidana: He is the first author to describe this disease under separate heading called “Medo Roga” in 34th chapter. He has mentioned Nidana, Lakshana and Samprapthi of this disease. 2. Sharangadhara Samhita: This textbook is known for its many unique things like Nadi pareeksha, clear definition of pharmacological terms etc. this author has explained madhu as the single drug treatment for Medovriddhi4. 3. Bhava Prakasha: Author has stressed more on the treatment aspects compared to Brihatrayi. Acharya Bhava mishra has explained regarding a popular Dhupa called “Malayanila Dhupa” in 39th chapter of Chikitsa sthana. He has also 8 explained regarding various Lepa and Udvartana to treat sthoulya. This author has explained sthoulya in separate chapter.c. Other Classical Texts:1. Bhela Samhita: It is one of the popular texts of Ayurveda. In 11th Chapter of sutrasthana,various aspects of Sthoulya have been explained.2. Vangasena Samhita:In this classical textbook, Medo Roga Chikitsa is explained in 16th chapter.3. Yogaratnakara: Sthoulya is explained under a separate chapter. Many of the formulationsto treat Sthoola are explained. Effect of Udvarthana in Sthoulya
  • Review of literature-Sthoulya4. Chakradatta: Acharya Chakrapani datta has explained treatment of Sthoulya in 36thchapter.5. Kashyapa Samhita: As this book gives more importance for “Koumarabruthya” and “Prasuthitantra”, hence Acharya Kashyapa have described “Medasvi Dhatri Chikitsa”5.Another specialty of this text is that Rakta mokshana is explained as Chikitsa forSthoulya.6. Bhaishajyaratnavali: It is famous for various treatment and preparations of medicines. In 39thchapter Sthoulya Chikitsa is explained.7. Gada Nigraha: 9 In 31st chapter, Sthoulya Roga and its Chikitsa is explained.8. Rasaratna Samucchaya: This book of Rasashastra, has explained Sthoulya in 18th chapter.9. Nidana Chikitsa Hastamalaka: This book of Ayurveda has been written in modern times by VaidyaRanajit Ray Desai. Here Sthoulya is explained in second volume. Effect of Udvarthana in Sthoulya
  • Review of literature-Sthoulya Physiological consideration of Meda Dhatu:Utpathi: When the sukshma bhaga of Mamsa dhatu comes in contact withMedodhatwagni then Meda dhatu is formed. Due to ambu guna present inMedas, sneha guna is increased. Mamsa dhatu gets paka due to its Agni andambu guna present in it forms Medo dhatu6.Guna – Karma: Medo dhatu is having the guru and Snigdha guna. It gives bala andbhrumanatva to the body7. It produces sneha and sweda in the body; it makesdrudata of shareera and gives poshana to Asthi dhatu8. Sneha in the body is ofthree types: 1.In the form of Medas which is Sandra & like Ghrutha 2. In the form of Vasa, which is present in Mamsa 3. In the form of Majja, which is present in Asthi9. 10Medodhara Kala: It is the third Kala, present in Udara and sukshma Asthi10.Medovaha Srotas and its Vidha Lakshana: These srotas are two in number. The moola is kati and vrukka. Vidhalakshana are Sweda (sweating), Snigdhata in anga (oily body), talu shosha(dryness of palate), stoola shopha (large swelling) and Pipasa (thirst).11Meda Dhatu Mala: Sweda is the mala of Meda dhatu12.Meda Dhatu Upadhatu: Snayu is the upadhatu of Medas13. Effect of Udvarthana in Sthoulya
  • Review of literature-SthoulyaMeda Dhatu Pramana: Two anjali is said to be the quantity of Meda dhatu.Meda sara purusha lakshana: Adhika snehansha in varna , swara, netra, kaksha, loma ,nakha, danta,oushta, mutra and pureesha. The person will have Dhana, Ishwarya, Sukha,Upabhoga. He will be Daana-sheelata, Saralata, Komalatha and Bhavakasuchaka14. It is also mentioned that these persons will have large body and unable toperform heavy work15.Meda Dhatu Vridhi Lakshana: Snigdhata of Shareera, vridhi of Udara and parshwa, kasa, swasa, hikka,dourgandha of shareera are seen as Meda vridhi lakshana16. It is also mentionedthat these persons will have Srama and increase in size of Spik, sthana and 11Udara17.Meda Dhatu Kshaya Lakshana: The depletion of this dhatu are seen as Plehavridhi, Sandhi Shunyatha,Rukshyata and Iccha of Athisnigdha and Mamsa18. The other symptoms areShunyata of Kati, Krusha shareera19. Effect of Udvarthana in Sthoulya
  • Review of literature-Sthoulya Sthoulya Nidana Nidana is an important factor for manifestation of any disease. Many atimes a disease can be diagnosed on the basis of nidana itself as in case of“Mrudbhakshanajanya Pandu”. The synonyms of nidana are Nimitta, Hetu, Ayatana, Prathyaya, Uttana,and Karana. Nidana can be broadly classified as Bahya nidana, which includesahara and vihara, and Abhyantara nidana being the Dosha and Dushya.Abhyantara nidana will be discussed in the context of Samprapthi. Bahya nidana can be compared with etiological factors in contemporaryscience. The etiological factors are scattered in classical textbooks of Ayurvedaunder different heading like: 1. santarpana karaka nidana20 2. Medo Roga hetu21 3. Athi sthoulya hetu22 12 4. Medo Mamsavaha srotodusti hetu23 5. Prameha Hetu24 6. Kapha Vruddhikara Hetu25All of these can be summarized as follows: 1. Aharatmaka nidana 2. Viharatmaka nidana 3. Manasika nidana 4. Sahaja nidana 5. Anya nidana1. Aharaja nidana: Food plays a major role in formation of Sthoulya and hence it is rightlysaid that wholesome and unwholesome foods are responsible for happiness andmisery. Effect of Udvarthana in Sthoulya
  • Review of literature-Sthoulya Aharaja nidana are wide spectrum of etiological factors, which is havingvariation in Ahara krama at one end, and Rasadi factors at another end. Thefollowing are the Aharaja Hetu: 1. Adhyashana 2. Athi matra ahara 3. Athi sampurana 4. Guru, sheeta, pichila, snigdha guna ahara 5. Madhura Rasapradhana ahara 6. Specific dravya pradhana aharaAdhyashana: Food that is consumed before the digestion of previous meal is called asAdhyashana. Here the patient will be not following the ahara ashta vidhavisheshayatana. 13Athi matra Ahara: Excess consumption of food is called as Athi matra Ahara sevana. Herethe consumption of food is related not only for quantity of intake but also thefrequency of intake. As the formation of Rasa is more, it over- nourishes theDhatu of the body; there by leading to Brihath Shareera.Athi sampurana: Intake of food up to ones full belly is called as Athi sampurana. To assessthe quantity of food in take the parameters had been explained in the classics26.Guru, sheeta, pichila, snigdha guna ahara: All these guna have an affinity towards the Kapha and the Medas there byleading to increase in their quality and quantity. More over due to Picchila andSnigdha guna, it causes the obstruction of the Vata in the srotas, in turn leads tosandukshana of Agni. Effect of Udvarthana in Sthoulya
  • Review of literature-SthoulyaMadhura Rasapradana ahara: This Madhura Rasa is having the Kapha prakopaka property because ofwhich there will be increase of Kapha and Medas. When the Madhura Rasa isadded to Snigdha guna then there will be more vitiation of Dosha.Table no.02 showing Ahara, which directly cause Sthoulya:Sl Nidana Ch. Su. As As Ma Bh YoNo Sam Sam San Hru Ni. Pr Ra.1 Adhyashana - + - - - - -2 Athi sampurana + - + - - - -3 Athi brumhana - - - + - - -4 Guru ahara + - + - - - -5 Madhura ahara + + + - + + +6 Kaphakara ahara - + - - + + +7 Snigdha ahara + - + - - - - 14 Some of the Nidana explained in different context can be considered forunderstanding Sthoulya Nidana.Table no 03 showing indirect Aharatmaka Nidana of Sthoulya:Sl Nidana Ch. Su. As As Ma Bh YoNo Sam Sam San Hru Ni. Pr Ra.1 Athibhojana + - - - - - -2 Sheeta ahara + - - - - - -3 Navanna + - - - - - -4 Navamadya + - - - - - -5 Gramya Rasa + - - - - - -6 Paya vikara + - + - - - -7 Dadhi + - - - - - -8 Sarpi + - + - - - -9 Ikshu + - + - - - -10 Guda + - - - - - -11 Mamsa + - - - - - -12 Godhuma + - - - - - - Effect of Udvarthana in Sthoulya
  • Review of literature-SthoulyaTable no.04 showing viharatmaka Nidana of Sthoulya:Sl no Nidana Ch. Su. As Ma Bh Yo Sam Sam Hru Ni. Pr Ra.1 Avyayama + + - + + +2 Avyavaya + - - - - -3 Divaswapna + + - + + +4 Sukha shayya + - + - - -5 Gandhamala dharana + - - - - -Table 05 showing Manasika Nidana of Sthoulya:Sl Nidana Ch. Su. As Ma Bh YoNo Sam Sam Hru Ni. Pr Ra.1 Harsha Nitya + - + - - -2 Achintana + - + - - - 153 Priyadarshana + - - - - -Table 06 showing Anya Nidana of Sthoulya:Sl Nidana Ch. Su. As Ma Bh YoNo Sam Sam Hru Ni. Pr Ra.1 Ama Rasa - - - - + -2 Snigdha Madhura basti + - - - - -3 Tailabhyanga + - + - - - Effect of Udvarthana in Sthoulya
  • Review of literature-SthoulyaTable no.07 showing important Nidana of Sthoulya with its features:Sl. Nidana Mahabhuta Rasa/Guna/ VitiationNo Predominance Veerya/Vipaka1 Guru ahara Pruthvi +Ap Madhura Rasa Kapha-Meda2 Snigdha ahara Pruthvi +Ap Madhura Rasa Kleda3 Picchila ahara Pruthvi +Ap Madhura Rasa Kapha-Meda4 Sheeta ahara Ap Madhura Rasa Vata-udaka5 Madhura Rasa Pruthvi +Ap Snigdha, guru Kapha-Meda6 Go ksheera Ap Madhura KaphaMeda7 Mahisha ksheera Ap + Pruthvi Athi sneha Kapha-Meda8 Dadhi Ap + Pruthvi Kapha-Meda9 Ghritha Agni + Ap Snigdha Kapha-Meda10 Ikshu Ap+ Madhura Kapha11 Phanitha Pruthvi + Ap Guru TriDosha12 Guda Pruthvi Madhura, kashaya Kapha-Meda13 Anupa Mamsa Ap + Pruthvi Madhura Rasa Kapha14 Athi Nidra - Tamo guna Kapha15 Sukha shayya - Tamo guna Kapha 1616 Divaswapna - Tamo guna Kapha17 Avyayama - Tamo guna Kapha18 Athi vyayama - Rajo guna Vata19 Jagarana - Rajo guna Vata20 Anashana - - Vata Effect of Udvarthana in Sthoulya
  • Review of literature-Sthoulya Sthoulya Samprapti It is defined as “the description of the evolution of the disease insequential order, commencing with Dosha-Dushya vaishyamya till the diseasemanifests completely. For the manifestation of a disease various derangedstructural and functional elements of the body are responsible and all such thingsare studied under Samprapti. The knowledge of Samprapti (also called as jathiand agathi) is very helpful to the physician both for accurate diagnosis and alsofor planning appropriate treatment. It is essential to know about “Ghataka” ofthe Samprapti because Samprapti vighatana itself is Chikitsa.Samprapti of sthoulya is understood as follows: 1. Samanya Samprapti of sthoulya 2. Samprapti Ghataka of sthoulya 3. Role of Ama in sthoulya 4. Analysis of important features of sthoulya 17Samanya Samprapti of sthoulya: The nidana of sthoulya will produces the Ama when there is anatmosphere in favour of them and prior to which there will be production ofreversible bond between Nidana- Dosha- Dushya27, which is must for themanifestation of the disease. This Ama after acquiring Madhuratwa along withsnehamsha, present in the body will produce vikrutha Medas. This will becomeobstacle for the nourishment of uttarottara dhatu resulting in under developmentof those dhatu. Accumulation of Medas resulting in Vata vridhi at koshta leadsto Athi sandukshana of Jataragni. This pradeepta Agni will be always in wants offood there by it makes a person to feel more of hungry otherwise leading tovarious derangements, but if food is taken it will nourish only the Medas. Thusthis vicious cycle results in the vridhi of certain anatomical region or all bodyparts. Effect of Udvarthana in Sthoulya
  • Review of literature-Sthoulya Samprapthi chakra Nidana sevana Ahara, Vihara, manasika Kostagni dusti Madhuratara anna Ama Rasa Medo Dhatwagni d t Atisneha utpatti Meda dhatu ati upachaya 18Beeja Ati Meda avarana Ati vrudha Meda dhatu causes anya dhatu Vata vrudhi in kosta dh Jataragni ati sandhukshana Anya dhatu asamyak upachaya Ati ahara sevana STHOULYA Effect of Udvarthana in Sthoulya
  • Review of literature-Sthoulya Samprapthi Ghataka Dosha: Kapha – Kledaka Vata - Samana, Vyana, Prana Pitta - Pachaka Dushya: - Rasa, Mamsa, Medha Agni: Jataragni - Pradeeptha Dhathwagni - Medadhathwagni manda. Ama: - Medadhathwagni manda janya Srotas: - Medovaha, Rasavaha Dusti prakara: - Sanga Udbhava sthana: - Amashaya Adhistana: - Vrukka, Vapa 19 Sanchara sthana: - Sarva daihika Vyaktha sthana: - All over body but mainly in Spik, Sthana, Udara. Vyadhi prakara: - Chirakari, Sadyasadyatha - Krucchrasadhya Roga marga: - Bhahya and Abhyantara Effect of Udvarthana in Sthoulya
  • Review of literature-SthoulyaBrief description about important Lakshana: 1. Meda- Mamsa Vrudhi: As it is a Meda Dhatwagni mandya janya vikara, the excess of formation of Medas along with its immediate poorva dhatu i.e. Mamsa dhatu is seen. The nidana like guru, picchila ahara and divaswapna and athi nidra will contribute to the vikara of Kapha. This Kapha is having the same qualities of Medas and hence Dosha-Dushya sammurcchana takes place leading for Vrudhi of Mamsa and Medas, which are Ama roopi. 2. Chalatwa of Spik Sthana and Udara: This is seen when more of Meda dhatu is present relatively more than Mamsa dhatu. Chalatwa is mainly appreciable in the Anatomical regions like Spik, Sthana and Udara. Here Medas is not properly adhered to the Mamsa dhatu and hence it moves freely giving rise to above 20 condition. 3. Ayatopachayotsaha: Because of the guru guna present in Kapha and Medas, it gives raises to vrudhita of tamasika guna of Manas in turn giving raise to sluggish movements to the body, and also due to Anga gurutwa this feature is seen. 4. Ayusrhasa: This lakshana is explained as one of the ashta Dosha of Sthoulya. The less span of life is seen, as it is one of the ashta nindita Vyadhi where Bahu Dosha are involved. When uttarottara dhatu formations are hampered, the Oja kshaya takes place, which is responsible for maintenance of ayu. Hence we see decreased lifespan in Sthoola purusha. Effect of Udvarthana in Sthoulya
  • Review of literature-Sthoulya5. Krucchra vyavaya: Shukra dhatu is responsible for vyavaya. When its rate of formation is reduced due to mandata of Meda Dhatwagni, there will be difficult in sexual act.6. Athi Sweda and Dourgandhya: Sweda is said to be mala of Medas. When there is increase in Meda dhatu, formation of its mala is also increased leading for excessive sweating. Due to excessive sweating, the Medasvi will have Durghanda in their body.7. Athi kshut and Pipasa: In sthoulya, vikrutha Vata will carry Agni from the Meda dhatu to amashaya, due to obstruction for the moment of Vata by picchilatha of Medas in the srotas of shakha. Hence pradeepthata of Jataragni is seen 21 leading for the symptoms like excessive thirst and hunger40. Effect of Udvarthana in Sthoulya
  • Review of literature-Sthoulya Poorvaroopa It refers to the features, which indicates the forth-coming disease. Itusually happens during (this corresponds with) fourth kriya kala called “Sthanasamsraya”. Clinically, this is important for early diagnosis, treatment andprognosis. Mild exhibition of actual features of disease itself can be consideredas Poorvaroopa.Poorvaroopa is of two types: 1. Samanya poorvaroopa 2. Vishesha poorvaroop Samanya poorva rupa gives the knowledge about forthcoming disease, butnot regarding the exact disease, where as Vishesha Poorvaroopa gives theknowledge regarding Dosha as well as the disease. 22 In the context of present disease, none of the Acharayas have stressedupon the poorva rupa, but it doesn’t mean that they are absent; in turn it is verydifficult to identify the features of poorva rupa during the process of diseasemanifestation. As per the directions given in Vata Vyadhi28, Urakshata29,Thrushna30 chapters, the initial manifestations of Sthoulya related symptomscould be considered as the premonitory symptoms or Poorva Rupa of Sthoulya31.Bahu Drava Sleshma and abhada Meda are two morbid components involved inpathogenesis of Prameha32, which are found vitiated in Sthoulya also. So KaphaSanchaya and Meda Dusti lakshana related Poorvaroopa of Prameha andMedovaha Srotodusti lakshana described by Acharya Sushrutha33 can beconsidered as poorva rupa of Sthoulya. In contemporary science this is termed as “Premonitory features” as seenin the conditions like leprosy etc. Effect of Udvarthana in Sthoulya
  • Review of literature-Sthoulya Rupa When the Vyadhi kriya kala is in fifth stage (Vyakthavastha), the disease will produces the features called as “Rupa”. These rupa will indicate the manifestation of disease34. Rupa is having synonyms like Samsthana, Vyanjaka, Linga, Lakshana, Chinna, and Akruthi35. Rupa includes both subjective symptoms as well as objective signs. This is the stage when Dosha -Dushya Sammurcchana is completed. Dosha -Dushya Sammurcchana is of two types:1) Prakruthi Sama Samavetha: Here the nature of mixing up of Dosha and Dushya is not intensive and hence both involved in a particular disease continue to maintain some degree of their identity in resultant disease. Therefore, clinically it is not difficult to identify the involved Dosha and Dushya based on lakshana. 232) Vikruthi Vishama Samavetha: The nature of mixing up of Dosha and Dushya are so much intensify that, it will be very much difficult to assess the Dosha and Dushya involved on the basis of the lakshana of disease. Ex. In Prameha, “Prabhuta Avila Mutrata” is neither the feature of Kapha nor the Medas. Sthoulya is a disease where inspection itself is suffixes for the diagnosis. In spite of that our Acharayas have explained some of the signs and symptoms, based on which it can be differentiated from other disorders where enlargement of body is seen as in case of Sarvanga shotha. Effect of Udvarthana in Sthoulya
  • Review of literature-Sthoulya The lakshana of Sthoulya had been described under different headings like:1. Sthoulya Lakshana362. Medo Roga Lakshana373. Sthoulya Ashta Dosha374. Medo Vrudhi Lakshana385. Medovaha Sroto Dusti Lakshana39 All the lakshana can be broadly classified as:1. Sthoulya Pratyatmaka Lakshana2. Sthoulya Samanya Lakshana1. Sthoulya Pratyamtaka Lakshana: The following are the diagnostic features of Sthoulya:a) Medo Vridhi (increase in fat) 24b) Mamsa Vridhi (increase in flesh)c) Chala Spik (Pendulous buttocks)d) Chala Udara (Pendulous abdomen)e) Chala Sthana (Pendulous breast)f) Ayatopachayotsaha (sluggish movement of body)2. Sthoulya Samanya Lakshana: Rest of the symptoms present in the table shows Samanya lakshana of sthoulya. Effect of Udvarthana in Sthoulya
  • Review of literature-SthoulyaTable no.08 Showing Sthoulya lakshana given by different authors:Sl. Lakshana Ch. Su. Ma Yo. Bh. Chi. Bas.No Sam Sam Ni Ra Pr San Raji1 Medo Vridhi + - + + + + +2 Mamsa Vridhi + - + + + + +3 Chala Sphik + - + + + + +4 Chala Udara + - + + + + +5 Chala Sthana + - + + + + +6 Ayatopachayotsaha + - + + + + +7 AyushahRasa + - - - - - -8 Javaparoda + - - - - - -9 Krucchra vyavaya + - + + + + +10 Dourgandha + + + + + + +11 Dourbalya + - + + + - +12 Swedadhikyata + + + + + + +13 Athi kshut + + + + + + +14 Athi pipasa + + + + + + +15 Kshudra swasa - + + + + + +16 Krathana - + + + + + -17 Gatra sada - + - - - + -18 Gadgada - + - - - - - 2519 Moha - - + + + + -20 Swapnadhikya - + + + + + -21 Alpa prana - - - - - + - Effect of Udvarthana in Sthoulya
  • Review of literature-Sthoulya Upadrava This manifests in last kriya kala. The condition in which furtherdevelopment of disease takes place after Rupavastha is called as “Bhedavastha”or “Upadrava”. 41 Upadrava is mainly due to the chronicity of the disease in which a propertreatment is not given. Sometimes due to virulence of Dosha-Dushyasammurcchana, with in a short period, this state is seen. It is sequel of the main disease. The sequel is so called because it isconsequent of the disease. The main disease is the primary and upadrava arebeing secondary. Upadrava may be major or minor ailment when compared withprimary disease. Usually, these will disappear when the primary disease istreated, but sometimes a separate treatment may require for upadrava due to itsmore virulence than the primary disease. Hence, a physician should always becapable of eliciting upadrava from the Roga and should give a proper treatmentfor what so ever is required. 26 As Sthoulya is an Asadhya Vyadhi, it will always have the tendency toexhibit upadrava. The concept of Sthoulya Ashta Maha Dosha42 can beconsidered as upadrava itself. Here Agni and Vayu are important factors forupadrava. Prakupita Vata due to its obstruction by Medas will make theSandukshana of Agni. This Pradeepta Agni digests the food as quick as fireburning the forest. Hence there will be Athi kshudha in the Sthoola. If the properquality and quantity of food is not supplied to this Teekshnagni, it will producehazardous effect, which may cause even death. Shiva Das Sen commenting on Charaka samhita states that “Vikaramdaruna” should be considered as Prameha, Pidaka, Jwara, Bhagandara, Vidradhiand Vata Roga. Dalhana opines that among the said Upadrava any one or all of them maypresent while commenting on “Vikarana anyatamam”. Same author oncommenting “Prapya panchatwam upayati” says that the person dies due to Effect of Udvarthana in Sthoulya
  • Review of literature-Sthoulyaupadrava. Bhava mishra and Yogaratnakara have used the word “Sudustara” inthe place of upadrava shabda.Table no.09 showing the Sthoulya upadrava:Sl. Upadrava Ch. Su. As. Bh. Yo. Ba. Chi.No Sam Sam Hr Pr Ra Raji San1 Prameha + + + + - + +2 Pidaka + + + + - - -3 Jwara + + + + - + +4 Bhagandara + + + + - + +5 Vidradi + + + + - - -6 Vata Roga + + - + - - -7 Udara - - + - - - -8 Urusthamba - - + - - - -9 Kusta - - - + - + +10 Visarpa - - - + + - +11 Athisara - - - + + - +12 Arshas - - - + + - +13 Slipada - - - + + - +14 Apachi - - - + + - +15 Kamala - - - + + - + 2716 Krimi - - - + - - +17 Thrushna - - - - - + -18 Moha - - - - - + -19 Vrana - - - - - + -20 Mutra krucchra - - - - - + -21 Kasa - - - - - + - Effect of Udvarthana in Sthoulya
  • Review of literature-Sthoulya Sadhyasadhyata Ancient scholars keeping in view of success rate of treatment haveexplained the concept of Sadhyasadhyata. The prognosis of the disease dependsupon the factors like Nidana, Kala, Desha, Bala, Ashraya, and Lakshana etc. Ifritu and Dosha (ritu swabhava Dosha and Vyadhi utpadaka Dosha) are similarthen the disease will be of bad prognosis (few exceptions like Jwara). If Doshaand Dushya are of similar nature then the disease is Asadhya43 (exceptions likeKaphaja Prameha). Hence the wise physician must analyze samprapthi ghatakafirst, and then start the treatment after explaining the prognosis of the disease tothe patient, or else if he handles the patient with bad prognosis he will lose bothname and fame44. So the knowledge of sadhyasadhyata is essential whileselecting medicine and therapy for the particular disease. Considering the above general principles, Sthoulya is treated as anAsadhya Vyadhi as there will be involvement of similar Dosha (Kapha) and 28Dushya (Medas). As it is a slow progressive condition continuous medicamentalong with general instruction are required. Hence the obese patients are rightlydescribed under “Ashta nindita purusha”. Brihatrayi opines that when comparison is made between Krusha andSthoola, the Krusha is better for the treatment, because it is difficult to bringback the Agni, Vata and Medas to equilibrium in case of Sthoulya45. As it is one of the Beeja swabhavaja Vyadhi, classical texts haveconsidered it as Asadhya for Chikitsa46. Effect of Udvarthana in Sthoulya
  • Review of literature-Sthoulya Sthoulya Chikitsa The process by which dhatu samyatha is achieved that is called as“Chikitsa”. As Sthoulya is a Santarpanajanya Vyadhi, Apatarpana Chikitsashould be given. To achieve the same our Acharayas have explained differenttypes of treatment modalities. As Vata, Kapha and Medas are important vitiatedfactors in Sthoulya, correction of these should be the main line treatment.Sthoulya is a multifactorial disease having involvement of factors like guruBhojana, athi Nidra etc., which will cause mandata of Meda Dhatwagni andvridhi of Jataragni, as a result of formation of uttarottara Dhatu will behampered. Moreover due to presence of Ama this disease requires holisticapproach to bring the Dosha and dhatu to their samyavastha, which is seen as“Laghavatha of Shareera”. The following are the different type of Chikitsa which are applied to treatSthoulya 29 1. Santarpanajanya Vyadhi Chikitsa 2. Satatakarshana Chikitsa 3. Guru cha Atarpana 4. Langhana Chikitsa 5. Pathyapathya with special importance to nidana parivarjana. Santarpanajanya Vyadhi Chikitsa: Procedures like Vamana, Virechana, Rakta mokshana, Vyayama,Upavasa and Swedana are been explained for all the disease, which areoriginated because of Santarpanakaraka ahara and vihara. Apart from the above,other medicines like honey with Haritaki choorna Rooksha Annapana,Triphaladi quatha, Musthadi quatha and Kustadi choorna47 are also advised totackle with Sthoulya. Effect of Udvarthana in Sthoulya
  • Review of literature-SthoulyaSatatakarshana Chikitsa: For the Sthoola rogi, karshana should be done continuously. Because of thekarshana there will be depletion of Mamsa as well as Meda dhatu, resulting inLaghavatha of Shareera48. Guru cha Atarpana: This is one of the basic line of treatment, which is mainly adopted, in theselection criteria dietary drugs for Medasvi. Meaning of “Guru Cha Atarpana” isthat those drugs which are heavy for digestion and having the Atarpana Guna.As the Jataragni is in Pradeepta avastha, hence guru guna dravya should beprescribed and at the same time these drugs should not nourish the dhatu. Drugshaving above properties are Prashatika, Priyangu, Shyamaka, Yava, Kodrava,Mudga, Kulatha Patola, Madhudaka etc.49Langhana Chikitsa 30 Acharya Charaka is explained about 10 different types of Langhana,which can broadly classify as1. Shodhana rupi langhana2. shamana rupi langhana1. Shodhana rupi langhana: Acharya Charaka has explained about the four types of Shodhana that canact as Langhana. They are:a. Vamanab. Virechanac. Niruha Basthid. ShiroVirechana Effect of Udvarthana in Sthoulya
  • Review of literature-Sthoulyaa. Vamana: This is the procedure done to expel out the utklista Kapha from the body.This procedure will aggravate Vata hence application of the same may not bechoice of therapy in Sthoulya.b. Virechana This is the choice of treatment for Pittaja vikara and also for Pittasthanagata Vata vikara as its action is seen in Pakvashaya also in the form ofVatanulomana. Hence this can be adoptable in the Sthoola.c. Niruha Basthi: To check the vikrutha Vata that is present all over the body, classical textshave explained about Basthi therapy, as it acts at the root level of Vata. ThisBasthi is of two types (Anuvasana Basthi & Niruha Basthi) depending on thedrugs used. In the context of Sthoulya, ancient scholars have explained about the 31administration of Niruha Basthi. Among all varieties of Basthi, Lekhana Basthistands in the first place to tackle the condition of Sthoulya.d. Shiro Virechana: This is done to expel the vikrutha Kapha present above neck. As it isexplained that “Nasa hi shiraso dwaram…” This may not have direct action overSthoulya, but it can defiantly helps to overcome some of the features of Sthoulyalike “Athi kshudha”. Effect of Udvarthana in Sthoulya
  • Review of literature-Sthoulya Pathyapathya This is the unique contribution of Ayurveda and explained for almost alldiseases. It plays an important role as much as of medicine and it is rightlymentioned that “if one follow Pathya, than there is no need of medicine and ifnot than also there is no use of therapeutic measures”. Acharya Charaka has stressed upon the Guru and Atarpana drugs as aspecial diet for Sthoola, which is already described. Commentators likeChakrapani50 and Gangadhara51 had mentioned that “sthoka bojana” or “Alpabojana” as the best karshana. They have also given weight-age for laghu androokshana ahara. Ahara dravya should be used after converting it in guruthrough samskara52. The following tables show various Pathya and Apathyaprescription for Sthoola. 32Table no.10 showing Ahararupi Pathya - Apathya for Sthoulya: Ahara varga Pathya ApathyaShuka dhanya Yava, Kodrava Godhuma, Navanna, shaliShami dhanya Mudga, Rajamasha, Kulatha, Masha, Tila ChanakaShakha varga Patola, vrunthaka Madhura phalaDravya Takra, Madhu, ushnodhaka, Dugda, draksha, Sarshapa Taila, Arista, Asava, navaneeta, grutha, dadhi Jeerna MadyaMamsa Rohita matsya Anupa, gramya Effect of Udvarthana in Sthoulya
  • Review of literature-SthoulyaTable no.11 showing Vihararupi Pathya - Apathya for Sthoulya: Pathya ApathyaSrama Jagarana Divaswapna AvyayamaVyayama Chintana Avyavaya Sukha shayyaShoka Krodha Nitya harsha AchintanaNitya bramana Sheetala jalapana 33 Effect of Udvarthana in Sthoulya
  • Review of literature-Obesity Lipids The term “lipids” is applied to a group of naturally occurring substances(plant and animal origin) characterized by their insolubility in water, greasy feeland solubility in some organic solvents.Lipid in diet: Lipids are consumed in the form of neutral fats, which are also known asTriglycerides. Triglycerides are made up of a glycerol nucleus and three fattyacids. These lipids form the major constituent in food of animal origin and muchless in food of plant origin. Apart from neutral fats, the usual diet also contains small quantities ofcholesterol and cholesterol esters.Digestion of lipids: The enzymes involved in the digestion of lipids are known as lipolyticenzymes. The tributyrase or gastric lipase present in gastric juice is not sufficientto digest the lipids due to its weak in terms of quality as well as quantity. The 34lipids are actually digested in small intestine. Bile salt takes key role in thedigestion. The other enzyme is pancreatic lipase1.Role of bile salts: The lipid molecules are insoluble in water due to its surface tension. Sothese molecules are not digested by any of the lipolytic agent. Due to thedetergent action of the bile salts, the lipids are made water-soluble and thisprocess is called as “Emulsification”. During this process the bile salts causeformation of aggregation of lipid in the form of “micelles”. The micelles containcholesterol, monoglycerides and fatty acids.Role of Pancreatic Lipase: It can digest only emulsified fat molecules. Pancreatic Lipase convertsmost of the Triglycerides into free fatty acids and monoglycerides but only a Effect of Udvarthana in Sthoulya
  • Review of literature-Obesitysmall part remains as diglycerides. The action of Enteric Lipase, present in smallintestine mucosa is negligible.Absorption of lipids: From the micelles, fatty acids, cholesterol and monoglycerides diffuseinto epithelia; cells in the mucosa of small intestine. The fatty acids with lessthan 12 carbon atoms diffuse directly into blood, which transports them throughportal vein to liver as unesterified fatty acids. The fatty acids with more then 12carbon atoms are converted into triglycerides by re-esterification. Now, thelipids remaining in the small intestine are aggregated into the chylo-microns bythe activity of Endoplasmic reticulum of the epithelial cells in the intestinalmucosa. Chylomicrons are mainly formed by Triglycerides and cholesterolesters and, are coated with layer of cholesterol, Phospholipids and some proteins.Chylomicrons cannot pass through the blood capillaries because of the largersize. So these lipid materials enter the lymph vessels and, are transported intoblood from lymph. 35Applied physiology: When digestion and absorption of lipids are affected, the stools becomefatty and bulky. This is called as “steatorrhea”. This occurs due to lack ofpancreatic enzyme during the disorders of exocrine part of pancreas. Thiscondition is also seen due to the absence of bicarbonate ions in pancreatic juice.Due to lack of bicarbonate ions, the bile salts are precipitated by the acidity ofthe chyme. So the lipids are not digested leading to “steatorrhea.”Transport of lipids: Most lipids, such as cholesterol and Triglycerides, are monpolar andtherefore very hydrophobic- molecules. To be transported in watery blood, suchmolecules are first made water-soluble by combining them with proteinsproduced by the liver and intestine. The combination thus formed is Effect of Udvarthana in Sthoulya
  • Review of literature-Obesity“Lipoprotein”. These are spherical particles that contain hundreds of molecule.In a lipoprotein, an outer shell of polar proteins plus amphipathic Phospholipidsand cholesterol molecules surrounds an inner core of hydrophobic Triglyceridesand cholesterol ester molecules. The protein in the outer shell are called“Apoprotein (apo) and are designated by letters A, B, C, D and E plus a number.Besides helping to solubilize the lipoprotein inn body fluids, each Apoproteinalso has specific functions2. There are several types of lipoproteins, each having different functions,but all essentially are transport vehicles: Lipoproteins are categorized and namedmainly according to their density, which varies with the ratio of lipids (whichhave a low density) to proteins (which have a high density). From largest andlightest to smallest and heaviest, the four major classes of lipoprotein areChylomicrons, very low-density lipoprotein (VLDL), low –density lipoprotein(LDL), and high-density lipoprotein (HDL).The following table no.12 shows different constituents of lipoproteins:Lipoprotein Protein Triglycerides Phospholipids Cholesterol 36Chylomicrons 1–2% 85 % 7% 6–7%VLDL 10 % 50 % 20 % 20 %LDL 25 % 5% 20 % 50 %HDL 40 – 45% 5 – 10 % 30 % 20 % Chylomicrons: These form in mucosal epithelial cells of the small intestine and contain exogenous (dietary) lipids. They contain small amount of fat-soluble vitamins. These enter lacteals of intestinal villi and are carried by lymph into venous blood (hence the milky appearance for plasma), and then into systemic circulation. Very low-density lipoprotein (VLDL):These forms in hepatocytes and contain endogenous Triglycerides. They carryTriglycerides, which are synthesized in hepatocytes to adipocytes. After Effect of Udvarthana in Sthoulya
  • Review of literature-Obesitydepositing some of their Triglycerides in adipose cells VLDL are converted toLDL Low-density lipoprotein (LDL): They carry about 75 % of total cholesterol in the blood and deliver it to cells through out the body for use in repair of cell membranes and synthesis of steroid hormones and bile salts. The only Apoprotein LDL contain is apo B100, which binds to LDL receptors for receptor – mediated endocytosis of LDL into a body cell. Within the cell the LDL is broken down, and the cholesterol is released to serve the cell’s needs. Once a cell has sufficient cholesterol for its activities, a negative feed back system inhibits the cells synthesis of new LDL receptors. When present in excessive numbers, LDL will also deposit cholesterol in and around smooth muscle fibers in arteries, forming fatty atherosclerotic plaques that increase the risk of coronary artery disease. For this reason, this cholesterol of LDL is called as ‘bad’ cholesterol. As some people have too few LDL receptors, their body cells cannot remove LDL from the blood; as a result their plasma LDL level is abnormally high and 37 they are more likely to develop vascular diseases. Moreover eating high fat diet increases production of VLDL inturn results in elevated LDL levels. High-density lipoprotein (HDL). It removes excess cholesterol from body cells and transports it to the liverfor the elimination. As this HDL prevents accumulation of cholesterol in theblood, a high HDL level is associated with decreased risk of coronary arterydisease and hence it is rightly termed as ‘good cholesterol’. Source and significance of blood cholesterol: There are two source of cholesterol:1. Food2. Synthesized by liver Effect of Udvarthana in Sthoulya
  • Review of literature-Obesity Food products like eggs, milk products, meat, beef, and pork. Etc. are therich source of cholesterol. Fatty foods in spite of devoid of any cholesterol willstill dramatically increase blood cholesterol level in two ways. First, a highintake of dietary fats stimulates reabsorption of cholesterol containing bile backinto the blood, so less cholesterol is lost in the feces. Second, when saturated fatsare broken down in the body hepatocytes use some of the breakdown products toproduce cholesterol.Liver and lipids: Function of liver in fat metabolism3:  A very high rate of oxidation of fatty acids to supply energy for other bodily functions  Formation of most of the lipoprotein.  Synthesis of large quantities of cholesterol and Phospholipids.  Conversion of large quantities of carbohydrates and proteins into fat 38 80% of cholesterol is synthesized in liver is converted into bile salts whichin turn are secreted into the bile. The remainder is transported in the lipoprotein,which are carried by blood to the tissue cell everywhere in the body.Exercise and lipids: Most of the energy is derived from carbohydrate during the first fewseconds or minutes of exercise, but at the time of exhaustion, as much as 60-85%of energy is derived from fats rather than carbohydrates.Assessment of blood cholesterol: In Laboratory blood cholesterol are assessed under lipid profile test. Effect of Udvarthana in Sthoulya
  • Review of literature-ObesityThe following table no.13 shows the normal limits of blood cholesterol.Sl.No. Blood Cholesterol Normal (Mg/Dl) High Risk1 Total cholesterol < 200 > 2392 LDL <130 > 1593 HDL > 40 -4 Triglycerides 10 - 190 -LDL cholesterol is calculated as follows: LDL = TC – HDL – (Triglycerides / 5) If the above mentioned normal range is exceeded then the condition istermed as Hyperlipidemia.Treatment for Hyperlipidemia:The following are the types of treatment for the Hyperlipidemia  Non-pharmacological measures, which includes low-fat diet exercise.  Pharmacological measures by using the drugs like Lovastatin (which block a key enzyme needed for the cholesterol synthesis.), colestipol (it promotes the excretion of bile in the feces.) 39The fate of lipids: Lipids, like carbohydrates, may be oxidized to produce ATP. If the bodyhas no immediate need to use lipids in this way, they are stored in adipose tissue(fat depots) through out the body and in the liver. A few lipids are used asstructural molecules or to synthesize other essential substances likePhospholipids (constituents of plasma membrane), lipoproteins (to transportcholesterol) and thromboplastins (for blood clotting).Triglycerides storage: A major function of adipose tissue is to remove Triglycerides fromChylomicrons and VLDL and to store them until they are needed for ATPproduction in other parts of the body. Effect of Udvarthana in Sthoulya
  • Review of literature-ObesityThe following table (no.14) shows the distribution of adipose tissue.SL.NO STORAGE SITE OF TRIGLYCERIDES PERCENTAGE1 Subcutaneous layer 50 %2 Around kidneys 12 %3 In omenta 10 – 15 %4 In genital area 15 %5 Between muscles 5–8%6 Behind eyes 5% Triglycerides in adipose tissue are continually broken down and re-synthesized. Thus the Triglycerides stored in adipose tissue today are not thesame molecule that were present last month because they are continuallyreleased from storage, transported in blood, and re-deposited in other adiposetissue cells.Regulation of energy release from Triglycerides: When excess quantities of carbohydrates are available in the bodycarbohydrates are used preferentially over Triglycerides for energy. There areseveral reasons for this “Fat-sparing” effect of carbohydrate. 40Lipid catabolism- lipolysis: Triglycerides stored in adipose tissue constitute 98% of all body energyreserves. They are stored more readily than is glycogen, in part becauseTriglycerides are hydrophobic and do not exert osmotic pressure on cellmembranes. Several tissues (muscle, liver and adipose tissue) routinely oxidizedfatty acids derived from Triglycerides to produce ATP; they must be split intoglycerol and fatty acids. This process is called as “lipolysis” (li-pol-i-sis) i.e.catalyzed by enzymes called lipases. Two hormones that enhance Triglyceridesbreak down into fatty acids and glycerol, are “Epinephrine” and“Norepinephrine”, which are realized when sympathetic tone increases, asoccurs during exercises. Other lipolytic hormones are cortisol, thyroid hormonesand insulin like growth factors. Insulin itself inhibits lipolysis. Effect of Udvarthana in Sthoulya
  • Review of literature-Obesity The glycerol and fatty acids that result from Liposis are catabolised viadifferent pathways. Glycerol is converted to glyceraldehyde 3-phosphate bymany cells of the body; one of the compounds also forms during the catabolismof glucose. If ATP supply in a cell is high, glyceraldehyde 3- phosphate isconverted into glucose, an ex of gluconeogenesis. Even collectively all of the manipulations to increase the blood glucoseare inadequate to provide energy supplies for prolonged fasting periods. Luckilythe body can adopt to burn more fats and proteins, which enter the Krebs cyclealong with glucose, break down products. The increased use of non-carbohydratefuel molecules (especially Triacylglycerols) to conserve glucose is called as“glucose sparing’ 3. As the body progress from the absorptive to the post-absorptive state, the brain continues to take its share of blood glucose butvirtually every other organ switches to fatty acids as its major energy sources,thus sparing glucose for the brain. During this transition phase, lipolysis beginsin adipose tissues and realized fatty acids are picked up by tissues cells andoxidized for energy. In addition the liver oxidizes fats to ketones and releasesthem into the blood for use by tissues cells. If fasting continues for longer then 4 41or 5 days the brain too begins to use large quantities of ketones bodies as well asglucose as its energy fuels.Lipid anabolism: Lipogenesis: Liver cells and adipose cells can synthesis lipids from glucose or aminoacid through Lipogenesis, which is stimulated by insulin. Lipogenesis can occurwhen a person consumes more calories than are needed to satisfy their ATPneeds. Excess dietary carbohydrates, proteins and fats all have the same fate.They are converted into Triglycerides. The glycerol and fatty acids can undergoanabolic reactions to become Triglycerides that can be stored or they can gothrough a series of anabolic reactions to produces other lipids such aslipoproteins, Phospholipids, and cholesterol. Effect of Udvarthana in Sthoulya
  • Review of literature-Obesity Etymology The word Obesity is derived from Latin term “obesus” which means:Ob → by reason ofEdo → I eatObesus → having eaten or having eaten until fatObesity → grossly fatDefinition: It is defined as “an abnormal growth of the adipose tissue due to anenlargement of fat cell size (hypertrophic) or an increase in fat cell number(hyperplastic) or a combination of both. Other definitions of obesity are as follows:  It is a state in which there is a generalized accumulation of fat in the body leading to more than 20% of the desirable weight.  Obesity is defined as BMI (Body Mass Index) above 25. 42  Obesity is a pathological condition characterized by an accumulation of body fat much in excess than that of necessary for optimal body function.  It implies an excess storage of fat. Most patients suffer from simple obesity but in certain conditions, it is anassociated feature. Even in later situation the intake of calories must beexceeding expenditure. Hormonal imbalance is often incriminated in women (ex.Post menopause or when taking contraceptive pills), but most of the weight gainin such cases is usually small and due to water retention. Effect of Udvarthana in Sthoulya
  • Review of literature-Obesity Synonyms of obesity Synonyms of obese  Plumpness  Fatty  Stoutness  Stout  Fatness  Corpulent  Over Weight  Buxom  Adiposity  Pert  Adiposis  Pulp  Liposis.  RotundPrevalence: It is most prevalent form of malnutrition in developed countries affectingadults as well as children. Obesity is a major public health problem in theindustrialized countries. It is extremely difficult to assess the size of the problemand compare the prevalence rates among the countries, as no exact figures areavailable4. The other reason for the same is lacking of standardization ofdefinition of obesity. However it has been estimated that twenty to forty percent 43of adults suffer from this disease in the developed countries like USA, UK. It isshown that fifty three percent of men aged twenty to seventy four and 1.3 to 1.5times women are obese in USA. These people spend 30-40 billion dollars everyyear on weight loss treatment. In developed countries this disease is more commonly seen in low socio-economic people where as in developing countries it is seen in higher socio-economical groups. A small study conducted recently in urban Delhi5 shown20% of men and 27.1% of women are obese (BMI > 25). Effect of Udvarthana in Sthoulya
  • Review of literature-Obesity AETIO-PATHOGENSIS The causes of obesity can be studied under three heading as it is usually done while dealing with the prevention of communicable as well as non- communicable disease. The three causative factors are referred to as “Epidemiological Triad”. They are: 1. Agent factor 2. Host factor 3. Environmental factor. In the disease Obesity, it is very difficult to separate all of these factors under different headings, as they are inter-related with each other. An attempt is made to understand these things as separate entities as much as possible. 1. Agent factor: In the disease the agent is defined as “a substance, living or non-living, or a force, tangible or intangible, the excessive presence or relative lack of which 44 4 may initiate or perpetuate a disease process” . The disease agents of obesity can be classified as follows:a) Nutrient agents: The eating habits of obese people are variable. Some eat three large meals a day, while other eats frequently five to six times a day. In both the cases excessive food intake is the cause for obesity. Not all obese patients eat more than average person, but all obviously eat more than they need. The foodstuff rich in fats are the key factor in the development of the disease. Even diets rich in simple sugars are also have definite role in the manifestation. Effect of Udvarthana in Sthoulya
  • Review of literature-Obesity It has been shown that obese patient eat more than they admit to eating, and over the years very small daily excess can lead to a large accumulation of fat. For example, 10.5 kcal excess would lead to a 10 kg weight gain over 20 years.b) Social agents: This disease is present more in effluent class of people in developing countries and in low socio-economic group in developed countries. As the poor people in developed countries can’t offer balanced diet, they are more prone to get affected. Due to increased sedentary life styles and frequent social kitty parties the people of economically rich group are affected in developing countries. 2. Host Factor: This is the intrinsic factor and is broadly classified as: I. Demographic characteristic like age, sex and ethnicity. II. Biological characteristic such as genetic factors, bio-chemical levels of blood and enzymes, physiological function of different organ 45 systems of the body. III. Social and economic characteristic like socio-economic status, education, occupation, stress etc. IV. Life style factors such as living habits, physical exercises, use of alcohol, drugs and smoking, behavioral patterns etc. ☻Age and sex: Obesity can occur at any age and generally increase with age. It has been well established that most adipose cells are formed earlier in life. Over feeding during infancy and early childhood by over enthusiastic mothers can be an important cause of obesity in adolescence and adults. It occurs in either sex and it is found that men gain weight between the ages of 29-35 while women gain most between 45-49 years of age. Women are more prone than men in gaining weight. Effect of Udvarthana in Sthoulya
  • Review of literature-Obesity☻ Genetic factors: It is very difficult to assess the role of genes in the manifestation ofobesity. But it is seen commonly in families. Re-feeding experiments inmonozygotic and dizygotic twins feed together or apart, suggest that geneticinfluences account for 70% of the difference in Body Mass Index (BMI) later inlife. Genetic factors have led to the discovery of a mutative gene, firstly in theobese (ob ob) mouse and now in humans. The ob gene was shown to beexpressed solely in both white and brown adipose tissues. The ob gene is foundon chromosome 7 and produce 16kDa protein called Leptin. In animalexperiment it has been proved that massively obese mouse; Leptin mRNA insubcutaneous adipose tissues is 80% higher than in controls. There are a numberof known genetic conditions such as Prader-willi syndrome and mutation in theLeptin gene, which produce a syndrome complex associated with obesity. The following table (no.15) shows the role of different genes inmanifestation of obesity6:GENE GENE PRODUCT MECHANISM 46Lep Leptin, a fat-derived hormone Mutation prevents Leptin from delivering satiety signal; brain receives starvationLepR Leptin receptor As abovePOMC Proopiomelanocortin, a Mutation prevents synthesis of precursor of several hormones melanocytes-stimulating and neuropeptide hormone(MSH) as satiety signalMC4R Type 4 receptor for MSH Mutation prevents reception of satiety signal from MSHPC-1 Prohormone convertase 1, a Mutation prevents synthesis of processing enzyme neuropeptide, probably MSH Whatever the role of genes may be, it is clear that environment plays animportant role, as evidenced by the fact that famine prevents obesity even in themost obesity prone individual. Effect of Udvarthana in Sthoulya
  • Review of literature-Obesity☻Bio-chemical levels of blood and enzymes:a). Leptin: Plasma levels of Leptin are also very high, correlating with BMI. But inhuman experiments have proved that abnormalities in Leptin are not the primecause of human obesity. Leptin secreted from fat cells could act as a feed backmechanism between the adipose tissue and the brain, acting as a “Lipostat”(adipostat), controlling fat stores by regulating hunger and satiety7. Leptin is a 16-kD protein that plays a critical role in the regulation ofbody weight by inhibiting food intake and stimulating energy expenditure.Defects in Leptin production cause severe hereditary obesity in rodents andhumans. In addition to its effects on body weight, Leptin has a variety of otherfunctions, including the regulation of haematopoiesis, angiogenesis, woundhealing, and the immune and inflammatory response. The LEP gene is thehuman homolog of the gene (ob) mutant in the mouse obese phenotype. A Leptin receptor has been found in the ventromedial nucleus of thehypothalamus and it is possible that changes in this receptor impair the effect ofLeptin. This would lead to a decrease in the release of transmitters such as 47neuropeptide Y, so that appetite would not be suppressed, interfering with thefeedback mechanism.b). Control of appetite: This is complex and depends partly on external stimuli, such as thecompany, the type of food, the surroundings and the person’s habitual behavior.Appetite is the desire to eat and this usually initiates food intake. Following ameal, satiation occurs. This depends on gastric and duodenal distention and therelease of many substances. Following a meal, cholecystokinin (CCK),Bombesin and Somatostatin are released from the small intestine and glucagonsand insulin from the pancreas. All of these hormones have been implicated in thecontrol of satiety. Centrally the hypothalamus – particularly the Para ventricularnucleus and the ventromedial wall – is thought to be the main satiety center.Numerous neurotransmitters (like CCK, opioids, serotonin, corticotrophin- Effect of Udvarthana in Sthoulya
  • Review of literature-Obesityreleasing hormone and particularly neuropeptide Y) have a role in the centralcontrol of satiation.c). Thermogenesis: Brown adipose tissue in animals8, when stimulated by cold or food,dissipates in the form of heat the energy derived from ingested food. This can bea major component of overall energy balance and it has been suggested that thismay also apply to humans. A β3-Adrenergic receptors6 are the principle receptors mediatingcatecholamine- stimulated lipolysis in brown and white fat tissue. After a mealor exposure to cold, relatively high concentrations of noradrenalin are released,stimulating the low-affinity receptors in brown adipose tissue. Low β3-Adrenergic receptor activity would decrease Thermogenesis and this can explainwhy most obese patients require a very low calorie intake to maintain any weightloss, and gain weight easily after only small calorie increases. Decreasedfunction of the receptors in white adipose tissues could slow lipolysis-causingretention of lipid in fat cells. As β3-Adrenergic receptors are more frequent in 48visceral adipose tissues, this would explain the regional distribution of fat inobese subjects.☻Occupation: Obesity is seen more in the people associated with sedentary life styleoccupations such as clerks, managers, housewives etc.☻ Life style factors -Physical activity: Obesity is rarely seen among persons who lead active lives. It is verycommon in those who lead sedentary lives. With extensive use of transportfacilities and mechanization of industry, the proportion of people who takeadequate exercise has decline and the number of persons leading sedentary liveshas been increasing. Obese patients tend to expend more energy during physicalactivity as they have a larger mass to move. On the other hand, many obese Effect of Udvarthana in Sthoulya
  • Review of literature-Obesitypatients decrease their amount of physical activity. The energy expended onwalking at three miles per hour is only 3.7 kcal/min and therefore increase inxercise plays only a small part in loosing weight. Uses of alcohol frequently willcause deposition of adipose as one gram of alcohol gives 7 kcal of energy.☻ Drugs: Some of the drugs like Corticosteroids; Sulphonilureas etc. will causeobesity in long-term use. The drugs, which are used to treat psychologicaldiseases like Carbamazepine, Phenobarbitone plays a key role in themanifestation of the disease- obesity.3. Environmental factors: This is an extrinsic factor that includes all that which is external to theindividual human host, living and non-living and with which he is in constantinteraction. This factor is again divided into: Physical environment: 49 This includes air, water and food. In Obesity only food factor is applicable which is already discussed. Biological environment: It includes universe of living things, which surrounds man like microbes,insects, animals and plants. All theses may not be applicable for Obesity. Psycho-social environment: It covers a complex of Psychosocial factors which are defined as “thosefactors affecting personal health, health care and community well being”. Theseare cultural valves, customs, habits, beliefs, attitudes, morals, religion,education, lifestyles, social and political organization. During some of the religious fests, sweets and oily rich recipes willprovide additional calories to man and will make him to suffer from Obesity in Effect of Udvarthana in Sthoulya
  • Review of literature-Obesityfuture. The country like India is rich in many customs and religious festivals andpeople of this country are more prone to get this disease when compared withother countries. Types of obesityIn simple the Obesity can be classified as:1. Exogenous obesity: A common form due to excessive intake of food. The distribution of fat is uniform, although somewhat excessive under the chin (double chin) and the abdomen. This is also termed as simple obesity or primary Obesity.2. Endogenous or glandular obesity: when being overweight is the primary complaint, an endocrine disorder is seldom the cause. This is also known as secondary Obesity9. 50 Obesity may be mild, moderate or severe, or as described by one author,“enviable”, “regal” or “pitiable”.The manner of distribution of fat may be of some diagnostic value.Distribution of fat: 1) Generalized type usually seen in alimentary or exogenous type. 2) Central or trunk type, involving only the trunk and neck. Ex: Cushing’s syndrome and Hypothyroidism. 3) Superior or buffalo type, involving the face, neck, arms and upper part of trunk. Ex Cushing’s syndrome and Hypothyroidism. Effect of Udvarthana in Sthoulya
  • Review of literature-Obesity 4) Inferior type, involving the lower part of trunk and legs (called lipodystrophia when accompanied by wasting of upper half of the body) 5) Girdle type, involving the hips, buttocks, abdomen and with a “fatty apron”, seen in pituitary or hypothalamic disorders. 6) Breeches or Trochanteric type, involving only the buttocks, as in the “Hottentots negro”, seen in Hypogonadal obesity. 7) Lipomatous type or multiple lipomataosis, with localized deposits of fat over the body (called Dercum’s disease or adiposis dolorosa when associated with tenderness and pain over the fatty lumps). Assessment of obesity 51 For the assessment of Obesity many formulations had been put forward.The following are different methods to assess the obesity in terms of weight andfat.1. Body weight: It is not an accurate measure to calculate excess fat, but is widely usedindex. In epidemiological studies it is conventional to accept +2 S.D (standarddeviation) from the median weight for height as a cut-off point for obesity. For adults, various other indicators are mentioned as follows: a.) Body Mass Index (Quetelet’s Index): = Weight in Kg / height in meter square. (Kg / m2) Effect of Udvarthana in Sthoulya
  • Review of literature-ObesityTable no. 16 showing the interpretation of BMI4:SL. BMI STAGE COMMENTSNO.1 < 16.00 Grade III thinness High mortality2 16.0-16.99 Grade II thinness High mortality3 17.0-18.49 Grade I thinness Moderate mortality4 18.5-24.99 Normal range Healthy5 25.0-29.99 Grade I obesity Moderate mortality6 30.0-39.99 Grade II obesity High mortality7 > 40 Grade III obesity High mortality b). Ponderal index10: = Height in centimeters / cube root of body weight i.e. cms / kg1/3 c.) Broca index: = Height in centimeters minus hundred (i.e. cms-100) d.) Lorentz’s formula: = Height in centimeters – 100 - height in centimeters – 150 Divided by 2 for women and 4 for men. 52 For women: Cms-100- Cms-150 2 For men: Cms-100- Cms-150 4 e.) Corpulence index: = Actual weight divided by desirable weight. This should not exceed 1.2 The B.M.I and the Broca index are widely used. A recentFAO/WHO/UNO reports gives the much needed reference tables for B.M.I,which can be used internationally as reference standards for assessing theprevalence of obesity in a community. BMI is better index of obesity comparedwith percent weight chart because it obviates the need for weight-height chart Effect of Udvarthana in Sthoulya
  • Review of literature-Obesityand unlike the later, is not affected by type of body built like light, medium andheavy.2. Skin Fold Thickness (SFT): A large proportion of total body fat is located just under the skin. Since itis most accessible, by measuring skin fold thickness obesity can be measured. Itis a rapid and “non-invasive” method for assessing body fat. Several varieties ofcalipers like Harpenden skin calipers are available. But considering its cost,Vernier calipers are used compromising for slight variation. The measurementsare taken at following sites11: a. Mid triceps b. Biceps c. Sub scapular and d. Suprailiac region. The sum of the measurements should be less than 40 millimeters in boysand 50 millimeters in girls or Triceps SFT alone is considered for assessmentand >18 and >32 mm in men and women respectively denotes obesity. Recent 53evidence indicates that SFT used in west is not applicable in India.Unfortunately standards for subcutaneous fat do not exist for comparison. Moreover in extreme obesity measurement may not be possible and main draw back isits poor repeatability.3. Waist – hip ratio (WHR): This is the waist circumference in centimeters divided by the hipcircumference in centimeters. The waist circumference is usually measuredhalfway between the superior iliac crest and the rib cage in the mid-axillary line.Where as the hip circumference is measured one-third of the distance betweenthe superior iliac spine and the patella. WHR in central distribution of body fats i.e. a waist hip circumferenceratio of more than 1 in men and more than 0.9 in women is associated with a Effect of Udvarthana in Sthoulya
  • Review of literature-Obesityhigher risk of morbidity and mortality than is a more peripheral distribution ofbody fat i.e. WHR less than 0.85 in men and less than 0.75 in women. The ratio of waist circumference to height or measuring the sagittaldiameter of the abdomen at the level of L4 / L5, provides a useful index of intra-abdominal fat content. The diseases associated with abdominal obesity includehypertension, Hyperlipidemia, insulin resistance, diabetes mellitus and cardio-vascular diseases4. Others: In addition to above, three well established and more accuratemeasurement is used for estimation of body fat. They are measurement of totalbody water, measurement of total body potassium, measurement of body densityand index of lean (non-fat) mass, or impedance analysis. This impendencedepends on the difference in electrical resistance between lean tissue and fat. Normal body fat content of an adult is 10-20% in men and 20-30% inwomen. The techniques involved are relatively complex and cannot be used for 54routine clinical purpose or for epidemiological studies. Abdominal fat can bemeasured using CT or MRI. The introduction of measuring fat cells has opened up a new field inobesity research. Above all just a simple look towards an undressed patient is sufficient todiagnosis the condition.Morbidity and Mortality: Greater the obesity higher the morbidity and mortality rates8. Forexample, men who are 10% over weight have 13% increased risk of death, whileincrease in mortality for those 20% over weight is 25%. The raise is less inwomen and in men over 65 obesity is not an independent risk factor. Weightreduction reduces this mortality and therefore should be strongly encouraged. Effect of Udvarthana in Sthoulya
  • Review of literature-Obesity Complication of ObesityThe following are the list of complications of Obesity11:  Type 2 diabetes mellitus  Hypertension  Stroke  Hyperlipidemia  Coronary heart diseases  Gall stones  Arthritis of hip, knee and foot  Varicose veins  Breathlessness  Sleep apnoea  Infertility  Hirsutism  Abdominal hernia  Depression  Cancers of breast, endometrium, ovaries etc. 55 Effect of Udvarthana in Sthoulya
  • Review of literature-Obesity TREATMENTThe treatments of Obesity can be studied under the following heading: 1. Non-pharmacological measures including dietary control and Behavioral Modification 2. Pharmacological measures 3. Surgical measures.1. Non-pharmacological measures:☻Dietary control: This largely depends on a reduction in calorie intake. The most commondiets allow a daily intake of approximately 4200 k joules (1000 k cal), althoughthis may need to be nearer 6300 k joules (1500 k cal) for someone engaged inphysical work12. A diet that is too low in total calories will usually result in the 56patient cheating and keeping to the diet only for short periods. Patients mustrealize that prolonged dieting is necessary for large amounts of fat to be lost. Apermanent change in eating habits is required to maintain the new low weight. Itis relatively easy for most people to lose the first few kilograms, but long-termsuccess in moderate obesity is poor, with an overall success rate of no more than10%. The aim of any dietary regimen is to lose approximately 1 kg per week.Weight loss will be greater initially owing to accompanying protein andglycogen breakdown and consequent water loss. After 3-4 weeks, incrementalweight loss may be very small because only adipose tissue is broken down andthere is no accompanying water loss. Effect of Udvarthana in Sthoulya
  • Review of literature-Obesity Patients must understand the principles of energy intake and expenditure.The best results are obtained in educated, well-motivated patients. An increase in exercise will increase energy expenditure and should beencouraged - provided there is contra-indication – since weight is usually notachieved without exercise. Weight cannot be lost by exercise alone. Regularexercise, however, will improve general health and often enables patients tocontrol their diet. The diet should contain adequate amount of each nutrient. A diet of 1000kcal per day should be made up of approximately 100 gm of carbohydrate, 50gm of protein and 40 gm of fat. The carbohydrate should be in the form ofcomplex carbohydrate such as vegetable and fruit rather than simple sugars.Alcohol contains which provides 7 kcal per gm, should be discouraged. Abalanced diet, attractively presented, is of much greater value and safer than anyof the slimming regimens. 57☻ Exercise: An increase in exercise will increase energy expenditure and should beencouraged - provided there is contra-indication – since weight is usually notachieved without exercise. Weight cannot be lost by exercise alone. Regularexercise, however, will improve general health and often enables patients tocontrol their diet.☻Behavioral Modification: Behavior therapy is a term, which covers wide variety of treatment atapproaches. This therapy is based on an attempt to produce permanent changesin behavior by involving the patient in his own management. Obese persons areaddicted by some behavioral pattern. This living pattern invites obesity, so thatthis therapy guides the patients to observe his current life style, eating habit,activities etc, and encourage changing it. The programs includes monitoring Effect of Udvarthana in Sthoulya
  • Review of literature-Obesity intake, modifying causes that signal “inappropriate eating”, modifying the act of eating itself, increasing exercise and self reward for more appropriate behavior. Self monitoring means keeping a written record of every thing eaten, the circumstances in which it was eaten. Elimination the case that signal inappropriate eating including controlling the environment in which the person is e.g. changing habit such as watching TV or studying, eating at late nights. These are all common problems of an obese person. Most obese people oscillate in weight; they often regain the lost weight, but many manage to lose weight again. This cycling in body weight may play a role in the development of coronary artery disease.2. Pharmacological measures: The following table (no.17) shows the drugs, their mode of action and 58 adverse effects: DRUG ACTION ADVERSE EFFECTS Fenfluramine Acts through serotinergic Primary HTN system in brain Valvular heart disease Dexfenfluramine As above As above Phentermine Acts centrally by reducing As above appetite Sibutramine Reuptake inhibitor of Cannot be used for long Norepinephrine term Orlistat Inhibition of intestinal lipase- Cannot be used for long malabsorption of fat term All these drugs can be used in the short term (max. of three months) as an adjunct to the dietary regimen6. Effect of Udvarthana in Sthoulya
  • Review of literature-Obesity Some of the researches are going on β3-Adrenergic receptors agonistsmay provide a new ray of hope for obese patients.Surgical Measures: Surgery to obese patients is indicated when their BMI exceeds 40.Operations that involve bypassing parts of the small intestine have fallen out offavour because of their side effects. Three procedures are in practice in thecondition of morbid obesity. 1.Wiring the jaws to prevent eating by which only liquids are allowed to consume. 2.Gastric plication through which a pouch is constructed by stapling across the wall of the stomach. 3.Gastric balloon is placed endoscopically inside the stomach and inflated. 59 Effect of Udvarthana in Sthoulya
  • Review of literature-UdvarthanaNirukthi: The word Udvarthana is derived from the root ud + vrith + bhavae + karaneva lyud This means vilepana or Gharshana.Paribhasha: In simple words, Udvarthana means rubbing of the body. It is a cleaningprocedure. It cleans Mala of skin by using drugs of fragrance. It is described as one of the Rookshana karma. The word meaning ofRookshana is making thin or the art of making thin. Acharya Charaka explainsthis Rookshana as one among the Shadvidhopakrama. The drugs having thequalities of Rooksha, Laghu etc are used for the procedures of Rookshana1. Thecharacteristic feature of Rookshana karma is that it surely prevents the outflowof substance irrespective of the nature of their mobility1a. Many a times Langhana karma is confused with Rookshana karma 60because of much similarity of guna of both the dravya and similarities in thetreatment effects.Table no.18 shows the difference between Langhana and RookshanaLanghana RookshanaGourava abhava Sneha abhavaLaghu guna pradhana Rooksha guna pradhanaDravya & adravya bhuta(ex.upavasa) chikitsa Only dravya bhuta chikitsaSara guna present in drugs Sthira guna present in drugs The dravyas of Rookshana karma will be dominated with Vayu pradhana,Agni and pruthvi mahabhuta2 and it is having kashaya pradhana, katu tikta rasa.The examples are yava and takra. Effect of Udvarthana in Sthoulya
  • Review of literature-UdvarthanaTable no 19 showing various effects of Rookshana karma: EffectsDosha Vata vardhaka, Kapha nashakaDhatu Vikruta Dhatu soshana, Balya, VarnyaMala Shoshana (dravamsha of mala)-performs sthambhana karmaTable no.20 showing Samyak Rookshana LakshanaLakshana Cha.sam3 Su.sam4 As.hr5 As.Sa6Samyak vata, mutra, mala Pravritti + + - -Hridaya Shuddhi + - + +Udgara Shuddhi + - + +Kanta Shuddhi + - + +Aasya Shuddhi + - - -Indriya Prasannatha - + + +Tandra Nasha + - + +Klama Nasha + - - -Sweda + - - - 61Ruchi + - + +Kshuth Sahodaya + + + +Pipasa Sahodaya + + + +Vyadhi Mardhava - - + +Utsaha - - + +Nirvyathe Antharatma + - - -Gatra Laghuta + + + +Table no.21 showing Rookshana athi yoga lakshana.Lakshana Ch.sam7, 8 Su.sam9 As.hr10 11Parva Bheda + - - -Anga Marda + - - -Kasa + + + +Mukha Shosha + + - -Kshuth Pranasha + - + +Aruchi + - - -Trishna + + + +Shrotra Netra Dourbalya + - + + Effect of Udvarthana in Sthoulya
  • Review of literature-UdvarthanaUrdva Vata + - + +Tamo Vrudhi + - - -Deha Bala Nasha + + - -Agni Bala Nasha + - + +Tandra - + - -Anidra - + + +Bhrama - + - -Klama - + - -Swara Kshaya - + - -Chardi - + + +Hikka - + + +Swasa - + + +Arochaka - - + +Sneha Kshaya - - + +Shukla Kshaya - - + +Oja Kshaya - - + +Swara Kshaya - - + +Basti Rukh - - + + 62Hridaya Rukh - - + +Murdha Rukh - - + +Jangha Rukh - - + +Uru Ruja - - + +Trika Ruja - - + +Parshva Ruja - - + +Jwara - - + +Pralapa - - + +Glani - - + +Para Asthi Bhedana - - + +Varcho Mutra Graha - - + +Jrumbha - - + + Effect of Udvarthana in Sthoulya
  • Review of literature-UdvarthanaTable no.22 showing Rookshana Ayoga Lakshana12, 13Lakshana Ch.samAOUSHADANAM DHATUNAM ASHAMO +(No relief from the diseases treatable from upakrama)ROGA VRIDHI (Aggravation of diseases) +Shodhana Ayoga +Ruthu Anusara Rookshana: Rookshana is indicated in Vasantha Ruthu in which Udvarthana withRooksha dravya, which are having kaphagna property, is beneficial14,15 .Modes of administration of Rookshana can be broadly classified as:1.Bahya Rookshana 2. Abhyantara RookshanaBhahya Rookshana can be achieved by doing Udvarthana, Lepa etc. 63Abhyantara Rookshana can be achieved by administering:Pana – Takrapana etc.Anna – Yavanna etc.Beshaja – Triphala Kwatha, Takrarishta etc. andBeshaja upakrama – Rookshana / Lekhana Basti. In this way the concept of Udvarthana is understood through Rookshanakarma. Effect of Udvarthana in Sthoulya
  • Review of literature-Udvarthana Historical background The concept of Udvarthana is as explained right from the oldest textbookcharaka samhita and all most all the other authors had explained this Rookshanakarma.1. Charaka Samhita: Basically Acharya Charaka explains this Udvarthana in the context of Dinacharya as Shareera Parimarjana. He says that it destroys Shareera Dourgandhya, Gurutwa, Tandra, Kandu, Arochaka, Sweda, etc. He advocates that Udvarthana karma should be done before Abhyanaga so as to maintain health.2. Sushruta Samhita: Acharya Sushruta explains that Udvarthana helps to bring back the Vikrutha Vayu to its normalcy. It decreases the fat and Vikrutha Kapha. It also provides smoothness and cleans to the skin and gives firmness to the body. He 64 further mentions that it also dilates the orifices of Sira and stimulates Brajaka Pitta. He is the first person to document the types of Udvarthana.3. Astanga Hrudaya: As per Acharya Vagbhata Udvarthana normalizes Vikrutha Kapha and liquefies the Medas. It provides firmness to body, smoothness to skin and increases the complexion of the skin. In Sarvanga sundari vyakhya it is described that Pravilayana refers to the dravikarana of Medas followed by making it Shoshana. The commentator has also mentioned about the usage of Kashaya choorna for Udvarthana, hence he defines Udvarthana as “ Udvarthanam kashayadi choorna Gatra karshanam” i.e. giving friction to the body by kashaya choorna is called as Udvarthana. 4. Yogaratnakara: In the context of “Nitya pravruthi prakarana” author has mentioned that Udvarthana normalize the increased Kapha and diminishes Medo dhatu. It Effect of Udvarthana in Sthoulya
  • Review of literature-Udvarthana increases Shukra dhatu, gives strength to body, increase blood formation, increases body complexion and makes skin smooth. The text also explains about “Mukhodvarthana”.Classification: Udvarthana can be classified as two types: 1. Udgharshana 2. Utsadana1. Udgarshana (Reinforced friction): “Ud + Grashana  gathradi karshanam” Acharya Dalhana says that “rubbing the body with powdered medicinewithout mixing oil or other Drava dravya is called as Udgarshana”16.Benefits: Vata Shamana, Kandu- Spota- Pidika nashaka, Sira shodhaka, Twakgata Agni vardaka, stimulates Brajaka Pitta. 65 Friction of body with brick powder excites the heat of skin, destroysitching and rashes etc.2. Utsadana (Rubbing): It is defined as: “Sasneha Kalkenodgarshanam Utsadanam”i.e. friction of body with drugs containing sneha or medicine mixed with oil orother dravya in the form of kalka is called as Utsadana. The benefits of this are:it improves complexion of females, gives good appearances, cleanliness, andbeautification.Difference between Abhyanga and Udvarthana: The main difference of Udvarthana from Abhyanga is that Udvarthana isdone in upward direction (prathiloma gathi) and Abhyanga is done in downwarddirection (anuloma gati). However the main intention behind Udvarthana is tobring the Rookshana in the body. Effect of Udvarthana in Sthoulya
  • Review of literature-UdvarthanaThe procedure that mimics the Udvarthana is Mardhana:Acharya Dalhana comments Mardhana as: “ Mardhanam tu gatam padabyama arambham kati parayatham”.i.e. Mardhana is a process of giving deep pressure from foot to waist, which is inprathiloma gathi. However Mardhana is being considered as a type of Abhyanga(as sneha dravya are used). Over all the benefits of Udvarthana as mentioned in different classicaltexts are as follows:Table no.23 Showing benefits of Udvarthana:Sl. Benefits Cha. Su As. Yg.No. Sam Sam Hr. Ra1 Dourgandya hara + - - -2 Gourava hara + - - -3 Tandra hara + - - - 664 Kandu hara + - - -5 Mala hara + - - -6 Aruchi hara + - - -7 Vata hara - + - -8 Kapha vilayana - + - -9 Meda vilayana - + + -10 Anga sthirikarana - + + -11 Twak prasadakara - + + +12 Kapha hara - - + +13 Meda hara - - - +14 Shukrada - - - +15 Balya - - - +16 Kanthi - - - +17 Twak mrudutwa - - - + Effect of Udvarthana in Sthoulya
  • Review of literature-Udvarthana Rubbing – Mode of Action Rubbing helps in the absorption of effusions, relief of blood stasis and carrying away the morbid products in the system. Deep pressure massage helps the interchange of tissue fluids by increasing the circulation in the superficial vein and lymphatics. The pressure helps the contents of the vessels move towards the heart, if applied strongly and quickly, it has a stimulating effect. It increases nutrition in all tissues. It removes fatigue, carrying away the increased products of combustion. Also it assists the reabsorption of serous fluid. Important qualities of rubbing are – It has got great influence on the muscles. It gives them a mechanical stimulation causing them to contract It increases circulation mainly in the veins. The alternate pressure and relaxation brings fresh blood to the part It improves the nutrition of the particular area It raises temperature locally 67 It increases elimination of waste products It increases secretion and absorption It improves the condition of the nervous system by stimulating the cutaneous nerve endings It influences the general metabolism when applied on large areas Helps to breakdown thickening and adhesions in subacute and chronic conditions Also helps in the reabsorption of inflammatory products and absorption of fat in fatty tissues. When rubbing is done lightly on the nerves for a short time it stimulates them.If applied down on each side of the spinal column, stimulates the spinal nerves andin a reflex way strengthens the heart. It affects the vasomotor nerves and there bywidens the blood vessels also influences the secretary nerves for increasing theirfunction. Effect of Udvarthana in Sthoulya
  • Review of literature-UdvarthanaPhysiological effect of rubbing The pressure of deep massage exerts a simultaneous influence up on allthe tissue of the body with in it reach up on the skin, fasciae, muscles, peripheralnerves, blood vessels, lymphatic and central nervous system. Further itaccelerates the activity of the heart, helps the assimilation of food and influencesgeneral metabolism of the body. As the skin covers nearly the whole body itssurface is affected by massage as well as the structures, which lie beneath it. Itincreases the cutaneous circulation and benefits the sensory nerve ending andinfluences the vasoconstrictors and vasodilators in the skin. The effect of rubbing up on muscle tissue is of vast importance. Thiseffects removal of fatigue products. Muscles in action exert a kind of massage upon each other. Ordinary movements of the voluntary muscle are a means ofaccelerating the blood by their alternate contractions and relaxations. At everycontraction blood is pressed out of the muscle, at the same time it receives an 68impulse to return to the heart, while during each relaxation fresh blood comes tothe muscle. Muscular fatigue from over exertion is relieved by massage. Toxicmaterials must be removed from the tissues in order to restore the normalfunctions of the body and this can be accomplished by rubbing. Influence of rubbing up on the circulation of fluid is also of greatimportance. Both the venous and lymphatic circulations are accelerated towardsthe heart. Deep manipulations cause the veins and lymphatic to be mechanicallyemptied and the fluid cannot return on account of the valves within the vessels.More space is thus made for blood returning from the deeper parts. The rubbing may be said to act both by pressure and by suction. Massagediminishes the blood pressure without increasing the activity of the heart. Butthe blood vessels are relaxed, distended and stretched by this. After a course ofthis treatment blood has been found to contain more red blood corpuscles and Effect of Udvarthana in Sthoulya
  • Review of literature-Udvarthanahemoglobin. These are not manufactured by rubbing. But brings them intocirculation instead of them remaining dormant in the system. Lymph flow is helped by rubbing exercises for the limbs both passive andactive increases the lymph flow. But prolonged inactivity tends to impendnormal nutrition because of defective drainage by lymphatic. Rubbing stimulates both motor and sensory nerve endings to various partsof the body. This stimulation is carried along the sensory fibers of a nerve to thespinal cord and hence to the brain. There it is transmitted through another set offibers to the same part and this is the reflex action of the nerve or spinal cord isdiseased or impaired. So that the communication is completely cut off, no suchaction results. The activity of motor nerves is increased by strong pressure. It isdiminished or destroyed. A strong stationary pressure on the affected musclemay stop cramps. Rubbing stimulates secretary nerves. This also influences 69vasomotor neurons. A short gentle stimulation applied to nerves containing bothvasoconstrictors and vasodilators tends to produce a contraction of blood vesselsbut a strong and continuous stimulation will produce dilatation, the skin becomesred and the part feels warms. Rubbing is an excellent form of passive exercise. Itis a part of physiotherapy, which will relieve pain, improves the strength andmobility. Motion of the molecules participates in chemical activity. It is known thatall materials participating in nutrition and support of the vital powers undergoradial chemical changes in their course through the organism and that it is onlyby and through these chemical process of composition and decomposition thatthe evolution of vital power in any of its form is possible. The motion of thecirculating fluids, vascular and intervascular is necessary to bring the elementsfor chemical change. Motions secure impact between the separate and distinctmolecules. This impact converts motor into chemical energy. The special andenergetic use of pressure motions is therefore the first and natural means adaptedto overcome the effects. Ill health co-exists with the presence of sub-oxides, and Effect of Udvarthana in Sthoulya
  • Review of literature-Udvarthanathat the degree of health, is measured by degree in which the oxidizing purposeof the system is attained. The true remedial relevancy of rubbing is readily seen,since its purpose and effects is to increases the degree of oxidation, to convertsub-oxides into complete oxides, which only are compatible with health.Procedure of Udvarthana The best time for Udvarthana is in the early morning between five and nine. Because in daily regimen it is mentioned before snana. Before doing Udvarthana, bladder and bowel should be emptied. Blood pressure, pulse rate, heart rate and respiratory rate should be recorded before doing Udvarthana. Udvarthana is started from legs, arms, chest, abdomen, back and gluteal region and is done in upward direction. Generally, duration is 30 to 45 minutes. After Udvarthana, patient should take rest for 5 to 10 minutes, which helps 70 the patient to relax.After relaxation, hot water bath is taken. Effect of Udvarthana in Sthoulya
  • Clinical StudyResearch Design: Present study is a two group clinical study with pre-test and post-testdesign.Setting for the Study: The scholar had selected the out patient department of Sri DharmasthalaManjunatheshwara Ayurveda Hospital, Hassan as the setting for the study.Population: Obese patients from all over Hassan district and other neighbouringdistricts and states who attended the Hospital were included in the study.Sample: The samples were selected from the population consisting of adultpatients of either sex, irrespective of religion, race, socio-economic status and 71education, satisfying the inclusion criteria.Grouping: A total number of 30 samples were selected and randomly allocated intofollowing groups.Group - A: Control group consisted of 15 patients, who were instructed tofollow the advised exercises and a calorie calculated dietary chart. The patientswere given Rechana (Purgation) with Trivruth lehya.Group-B: Experimental group consisted of 15 patients, who were givenRechana with Trivruth lehya followed by Udvarthana with Triphaladi choornafor 7 days. The method of preparation of Triphaladi choorna is discussed in drugreview context. After completion of Udvarthana again Rechana was given withTrivruth lehya. Here also the patients were asked to follow exercises and a Effect of Udvarthana in Sthoulya
  • Clinical Studycalorie calculated dietary chart similar to that of Group A, except on the days ofpurgation. The samples were under direct observation of the investigator for the first9 days of their hospital stay and then onwards they were asked to visit hospitalafter 1 month for follow-up.Hypothesis:Null-hypothesis: Udvarthana is not effective in reducing weight.Alternate –hypothesis: Udvarthana is effective in reducing weightReasons for selecting the Research design: For a scientific trial, proper design is required so as to assess the efficacyof the therapy, in turn to meet the objectives. Here two groups i.e. Group-A andGroup-B have been selected. Except Udvarthana, all the treatment modalities 72like purgation, physical exercise and diet were common for both the groups.Hence Group-B will highlight the efficacy of Udvarthana. As it has already been discussed that sthoulya is a multifactorial diseaseand a holistic approach is required for the same, so the modalities like exercise,Udvarthana and diet have been included in the study. Moreover, no treatment iscompleted unless proper Ahara and Vihara are followed along with themedicine. Pathya in terms of calorie calculated diet is having its own role. Hence adiet chart, which provides energy, that is just a little more than that of the BasalMetabolic Rate (BMR) i.e. 1200 to1400 kcal is allowed to the patients. Theconcepts like low fat and high fibers have been considered while preparing thechart. As the samples were not just restricted to a small geographical area, thischart was modified keeping in view their Desha, Satmya, kala and udyoga. Effect of Udvarthana in Sthoulya
  • Clinical StudyHowever a standard diet chart is enclosed in annexure, considering their natureof food habits and calorie. Proper dynamic exercises are required to burn off the calories present inthe body in the form of adipose tissue. All the 30 patients were advised to followdynamic exercises for duration of one hour in morning and evening on all thedays of the study in the hospital except on the day of purgation and subjectswere advised to follow the same at their house after discharge. The list ofexercises is enclosed in annexure. The samples underwent Physiotherapyexercises as advised, which included stepper, tread-mail, shoulder-wheel, pulley,vibrator, cycle, etc. Sweda is believed to be the mala of meda dhatu; hence to remove excesssweda from vikrutha medas, swedana karma in the form of Sarvanga bashpasweda has been done to the patients following Udvarthana. 73 As it is a medavrita vata janya vyadhi, after vilayana of medas throughUdvarthana, to check the vikrutha Vata, Rechana was given for the purpose ofVatanulomana. Udvarthana was selected for Group B patients on the basis of theassumption that it can initiate the process of lipolysis and helps in thetransportation of lipids from the periphery to the liver, where it will bemetabolized into fatty acids to yield energy. On this hypothesis the present studyhas been designed. This study has been designed after conducting sufficient number of pre-clinical trials and during which no adverse effects were noticed; therefore thestudy was taken up for detailed analysis. No internal medicines were advised for the patients. All the patients ofeach Group were asked to come for follow up after one month. Keeping in view Effect of Udvarthana in Sthoulya
  • Clinical Studyof practical problems and limitations of time, the investigator has bondedhimself for one month observations to check further changes in the weight. Thesample size in both the groups were small i.e. 15 patients, but considering thetime limitation and the technical problems, the scholar had restricted himself fora total of 30 patients.Objectives of the Study: 1. To study the concept of sthoulya as per the Ayurvedic texts and their discussions with current medical prospective. 2. To evaluate the effect of Udvarthana as the therapeutical aid in the patients of sthoulya (in terms of weights and biochemistry). 3. To see the effect of Udvarthana in relieving the associated symptoms like Atisweda, Dourgandhya etc. 74 4. To survey the obese patients attending the O.P.D of S.D.M.C.A&H, Hassan, irrespective of their complaints.Selection Criteria:Inclusion Criteria: 1. Patients complaining of symptoms related to sthoulya as per the classics. 2. Patients who were already diagnosed as obese. 3. Patients not responding to the expectations with textual prescription irrespective of system of medicine. 4. Patients who’s Body Mass Index is equal or above 30, irrespective of sex. 5. Patients of uncomplicated hypertension and arthritis who are under control and under treatment were also selected for study. 6. Obese patient detected or diagnosed to be having Hyperlipidemia. Effect of Udvarthana in Sthoulya
  • Clinical Study Exclusion Criteria: 1. Obesity due to other disorders like secondary obesity as seen in Cushing syndrome, Hypothyroidism etc. 2. Patients with previous history of cardiac disorders and other systemic disorders. 3. Obesity observed since birth were excluded. Assessment criteria: Assessment was made based on subjective and objective parameters is as follows: Objective parameters: 1. Weight 2. BMI 3. Circumference of Chest, Abdomen, Hip, Mid-arm, Mid-thigh 75 Subjective parameters: Various features of obesity had been considered and grading was given to analyze the results statistically as follows.1. Assessment of chala spik, stana and Udara a. Absence of chalatva grade 0 b. Chalatva during fast movement grade 1 c. Chalatva during moderate movement grade 2 d. Chalatva during slight movement grade 32. Assessment of Ayata upachaya, utsaha hani (sluggish movement of body) a. Unimpaired utsaha grade 0 b. On desire can work sluggishly but properly grade 1 c. On desire can work sluggishly but improperly grade 2 d. Even on desire do not like to work grade 3 Effect of Udvarthana in Sthoulya
  • Clinical Study3. Assessment of Sweda adikyata (At normal condition and at comfortable zone i.e. temperature of 270 c, humidity of 65%) a. No sweating grade 0 b. Profuse sweating after moderate work grade 1 c. Profuse sweating after slight work grade 2 d. Sweating even in resting condition grade 34. Assessment of Ayase Swasa (dyspnoea on exertion) a. Absent grade 0 b. Dyspnoea on moderate work grade 1 c. Dyspnoea on slight work grade 2 d. Dyspnoea even at rest grade 35. Assessment of Nidradhikya (excessive sleep) a. Normal sleep of 6-7 hours per day grade 0 76 b. Normal sleep of 8 hours per day grade 1 c. Normal sleep of 10 hours per day grade 2 d. Normal sleep of more than 10 hours per day grade 36. Assessment of Athi kshudha (excessive hunger) a. Feels hunger at next annakala only grade o b. Feels hunger for once in between Anna kala grade 1 c. Feels hunger for more than twice grade 2 d. Feels hunger always grade 37. Assessment of Ahara matra (total quantity of food intake) a. Takes food in moderation grade 0 b. Takes one time food up to satiety grade 1 c. Takes two times food up to satiety grade 2 d. Takes food always up to full satiety grade 3 Effect of Udvarthana in Sthoulya
  • Clinical Study8. Assessment of Ahara kala (frequency of food intake) a. Two large meals a day grade 0 b. One small meal and two large meals a day grade 1 c. Three large meals a day grade 2 d. More than three meals a day grade 39. Assessment of kshudha souhitya (feeling of satiety after food) a. Feels comfort after food grade 0 b. Feels discomfort but performs routine work grade 1 c. Feels discomfort and hampers routine work grade 2 d. Feels discomfort and unable to perform work grade 310. Assessment of kshudha sahatva (tolerance of hunger) a. Can tolerate hunger more than two meal time grade 0 b. Cannot tolerate hunger more than two meal time grade 1 77 c. Cannot tolerate hunger more than one meal time grade 2 d. Cannot tolerate hunger even for one meal time grade 311. Assessment of Athi Pipasa (excessive thirst) a. Normal thirst grade 0 b. Up to one liter excess intake of water / fluids grade 1 c. Up to two-three liter excess intake of fluids grade 2 d. More than three liter excess intake of fluids grade 312. Assessment of Alpa vyayama (decreased physical exercises) a. Can do routine exercises grade 0 b. Can do moderate exercise with difficulty grade 1 c. Can do only mild exercises with difficulty grade 2 d. Cannot even do mild exercises grade 3 Effect of Udvarthana in Sthoulya
  • Clinical Study13. Assessment of Alpa vyavaya (decreased sexual attitude) a. Unimpaired libido and sexual performance grade 0 b. Decreased libido but can perform sexual act grade 1 c. Decreased libido, sexual act with difficulty grade 2 d. Loss of libido and cannot perform sexual act grade 314. Assessment of Anga gourava (feeling of heaviness) a. No heaviness in body grade 0 b. Feels heaviness but it doesn’t hampers routine work grade 1 c. Feels heaviness which hampers routine work grade 2 d. Feels heaviness which restricts routine work grade 315. Assessment of Anga sithilatha (flabbiness of body) a. No flabbiness in body grade 0 b. Flabbiness in one anatomical region grade 1 78 c. Flabbiness in more than one region grade 2 d. Generalized flabbiness in body grade 316. Assessment of Gatra sada (fatigue) a.can perform work without fatigue grade 0 b. can perform work with little fatigue grade 1 c. can perform work with Moderate fatigue grade 2 d. can’t perform any work grade 3 Materials: The following materials are required for the clinical study:  Triphaladi Udvarthana Choorna  Trivruth lehya  Weighing machine  Measuring tape Effect of Udvarthana in Sthoulya
  • Clinical Study Drug Review In the present study some of the drugs, which are having Rookshana property had been selected. The following tables shows the important features of the drug which are used for Udvarthana choorna Drug Latin Kula Paryaya Rasa Guna Virya Vipaka name (Family)Haritaki Terminali Haritaki AbhayaLavana Laghu Ushn Madhur -a (combretacea Pathyavarjitha Ruksha chebula e) Rohini pancharas Kashaya rasa PradhanaAmlaki Emblica Euphorbiace- Dhatri Lavana Guru Sheet Madhur officinalis ae Amlaja. varjitha Ruksha pancharas Sheeta Amla rasa PradhanaVibitaki Terminali Combretace Karshapha Kashaya Laghu Ushn Madhur -a belirica -ae laAksha Ruksha KalidrumaMudga Vigna Shimbi Kashaya Laghu Sheet Katu radiata (leguminosa Madhura Ruksha 79 -e)Kulatha Cassia (leguminosa Chakshyus- Tikta, Ruksha Sheet Katu absus -e) ya Kashaya KulaliSarshap Brassica Ragika Katusneha Katu Tikshna Ushn Katu compestri (cruciferae) Tantubha Tikta SnigdaMethika Trigonella Shimbi Pitabeeja Katu Laghu Ushn Katu foenum (leguminosa Snigda -e) Yava Hordeum (gramineae) Java Madhura Laghu- Sheet Katu vulgarae Kashaya Ruksha Effect of Udvarthana in Sthoulya
  • Clinical Study Dravya Chemical Bhahya Prayoga Dosha Rogagnata Prayojya Composition -gnata Anga Haritaki Chebulagic Shothahara, VPK Srotoshodana Phala acid, Tannin Vrana Shodhana Prameha, kusta Corilagin Vedanasthapana Arsha, Amlaki Gallic acid Dahaprashamana VPK Prameha, Phala Tannic acid, Chakshushya Kusta, Vit-c Keshya Shotagna Vibitaki Tannin Shothahara, VPK Kapha vikara Phala Galic acid Raktastambhana Medo vikara, Ethyl gallate Vedanasthapana Rasa vikara Mudga Potassium, - PK Prameha, kusta Beeja Vitamin A,B,C,K Kulatha Chaksine Neetra roga PK Medo roga Beeja Isochaksine Ashmari Sarshap Sinalbin, Lekhana VK Kusta Beeja Sulphosianide Varnya P Taila Vedanasthapana Methika Volatile oil, Vedanasthapana VK Shotha, Panchang Calcium Shothahara Vidradhi 80 Yava Protein, Iron - PK Mutrakruchra Panchang Calcium V Prameha, Kasa Phosphorus Trishna,Peenasa V-Vata, P-Pitta, K-Kapha, -Prakopa, - ShamanaTable – showing the ingredients and their quantity in Triphaladi choorna.Ingredients Part used PartsTriphalaHaritaki Choorna Phala 2 partsVibhitaki ChurnaAmlaki ChurnaKulatha Beeja 4 partsMudga Beeja 1 partYava Beeja 2 partsMethika Beeja 1 partSarshapa Beeja 1/4th partThe drugs and their proportions have been standardized after pilot study. Effect of Udvarthana in Sthoulya
  • Clinical StudySource of Drugs All the raw drugs for the preparation of Udvarthana choorna wereprocured from S.D.M College of Ayurveda Pharmacy, Hassan.Preparation of Udvarthana Choorna All the ingredients in suitable proportions are made into sukshma choornaseparately then they are mixed together.Trivruth lehya: This drug is used for Rechana (purgation) in both the groups.Table showing the properties of Trivruth:Latin name: Operculina turpephumFamily: convolvelaceaeParyaya: Tribandi, Nishotha 81Rasa: Kashaya, MadhuraGuna: RookshaVeerya: ushnaVipaka: KatuChemical composition: Turpethin, volatile oilsDoshagnata: Kapha- pitta shamanaRogagnatha: Jwara, Shotha, Udara, Pleeha, Pandu, VranaTrivruth lehya was taken from Arya Vaidya Sala, Kottakkal, Kerala.Treatment Procedure: After completion of exercises, the patients were made to lie on table withminimal clothing. A total of 400 gm of Udvarthana choorna is taken every time.Massage with this herbal powder was done in ‘pratiloma gati’ i.e. against thedirection of hair follicles. Massage was done in all following seven consecutivepostures for a period of 5 minutes in each, with a total duration of 35 minutes. Effect of Udvarthana in Sthoulya
  • Clinical Study 1. Sitting 2. Supine 3. Left lateral 4. Dorsal 5. Right lateral 6. Supine 7. Sitting After Udvarthana, the subjects underwent Sweda karma (Sarvanga bashpaSweda with Dasha moola kwatha).Materials for diagnostic study: To measure circumference of mid-arm, mid-thigh, abdomen, chest andhip, measuring tape was used. A standard Weighing machine was used tomeasure weight and it is noted in kg. 82Materials for laboratory investigations: The investigations are carried out in an “Auto analyzer”. Lipid profile testwas done before and after treatment, in empty stomach. This test includes  Total cholesterol  HDL  Triglycerides  LDL {= TC – HDL – (Triglycerides / 5)}The following table shows the name of the reagents used for the study.Test Name of the reagent MakerTotal cholesterol Total cholesterol liquid kit Diagnostica, Bantwal.HDL HDL cholesterol precipitating set Diagnostica, Bantwal.Triglycerides Triglyceride liquid reagent set Diagnostica, Bantwal. Effect of Udvarthana in Sthoulya
  • Clinical Study Before UdvarthanaDuring Udvarthana with Triphaladi choorna1 832 Effect of Udvarthana in Sthoulya
  • Observation & Results Technological efficacy of sciences has lead to wide acknowledgement ofeffectiveness of its method. Standards of testability, verifiability and morerefined criteria of falsifiability as filters for legitimate knowledge have beenbrought about by ceaseless development of science. Ingenuity of science is seenin its method. It is experiments that give impetus to scientific knowledge. For any research work, the data should be collected systemically and mustbe presented in such a way that the reader can understand the things in a bettermanner. Here onwards the data will be presented in tabulations, graphs andpictographs. As these are self-explanatory descriptions are given whereverrequired. Observations:Table no.24 Showing Age-wise Distribution of Sthoulya Cases in Group A & B: 83Age Group Group A % Group B % Total % 18-30 05 33.33 03 20.02 08 26.66 31-40 05 33.33 04 26.66 09 30.00 41-50 03 20.01 04 26.66 07 23.34 51-60 02 13.33 04 26.66 06 20.00 61-70 00 00.00 00 00.00 00 00.00 71-80 00 00.00 00 00.00 00 00.00 Total 15 15 30Table no.25 showing sex wise distribution: Sex Group A % Group B % Total % Male 07 46.67 05 33.33 12 40.00 Female 08 53.33 10 66.67 18 60.00 Total 15 15 30 Effect of Udvarthana in Sthoulya
  • Observation & ResultsChart- Showing Agewise distribution of obese patients: 9 8 7 18-30 6 31-40 5 41-50 no.of patients 4 51-60 3 61-70 2 1 71-80 0 Group A Group B Total Chart- Showing sex wise distribution: 12 18 Total 10 Group B 5 Group A 7 8 0 5 10 15 20 25 30 35 84 Male FemaleChart- Showing Distribution of Associated Features in both Groups: 35 30 25 20 15 10 5 0 Group A Group B Total Pipasa Kshuda Swasa Dourgandhya Athi Sweda Srama Athi Nidra Effect of Udvarthana in Sthoulya
  • Observation & ResultsTable no.26 Showing Distribution of Sthoulya Cases in Group A and Baccording to Religion: Religion Group A % Group B % Total % Hindu 11 73.34 12 73.34 23 76.67 Muslim 03 19.99 03 19.99 06 20.00 Christian 01 06.67 00 06.67 01 03.33 Total 15 15 30Table no.27 Showing Distribution of Sthoulya Cases in Group A and Baccording to Socio-economical status Status Group A % Group B % Total %Low 00 00.00 00 00.00 00 00.00Middle 06 40.00 05 33.34 11 36.66High 09 60.00 10 66.66 19 63.34Total 15 15 30 85Table no.28 Showing Distribution of Sthoulya Cases in both Groups occupation:Occupation Group A % Group B % Total %House wife 04 26.66 08 53.31 12 40.00Business 04 26.66 02 13.34 06 20.00Clerk 03 20.00 01 06.67 04 13.33Teacher 02 13.34 01 06.67 03 10.00Engineer 01 06.67 01 06.67 02 06.67Student 01 06.67 02 13.34 03 10.00Total 15 15 30Table no.29 Showing Distribution of Sthoulya Cases in Group A and B as perPrakruthi: Prakruthi Group A % Group B % Total % Vata-Kapha 09 60.00 10 66.67 19 63.34 Pitta-Kapha 06 40.00 05 33.33 11 36.66 Total 15 15 30 Effect of Udvarthana in Sthoulya
  • Observation & ResultsTable no.30 Showing Distribution of Sthoulya Cases in both Groups accordingto chronicity: Chronicity Group A % Group % Total % (In Years) B Less than 10 10 66.66 10 66.66 20 66.66 11-20 03 20.02 02 13.34 05 16.66 21-30 01 06.66 02 13.34 03 10.00 31-40 01 06.66 00 00.00 01 03.34 41-50 00 00.00 01 06.66 01 03.34 Total 15 15 30Table31 Distribution of Sthoola in both Groups according to Family historyFamily History Group A % Group B % Total %Negative 02 13.34 02 13.34 04 13.34Maternal +ve 05 33.34 05 33.34 10 33.34Paternal +ve 02 13.34 03 19.98 05 16.66Both +ve 06 39.98 05 33.34 11 36.66 86Total 15 15 30Table no.32 Showing Distribution of Sthoulya Cases in Group A and B as perquantity of food consumption:Quantity Group A % Group B % Total %of FoodLess 00 00.00 00 00.00 00 00.00Moderate 04 26.66 06 40.00 10 33.34More 11 73.34 09 60.00 20 66.34Total 15 15 30 Effect of Udvarthana in Sthoulya
  • Observation & ResultsTable no.33 Showing Sthoola in both groups according to frequency of foodconsumption:Frequency of Group % Group % Total %food intake A B2 times 00 00.00 00 00.00 00 00.003 times 03 20.00 07 46.67 10 33.344 or more 12 80.00 08 53.33 20 66.34Total 15 15 30Table no.34 Showing Distribution of Sthoulya Cases in both Groups as perPana”:Pana Group A % Group B % Total %Sitambu 12 80.00 09 60.00 21 69.99Fruit juice 13 86.00 10 26.67 23 76.67Butter milk 02 13.34 04 26.34 06 19.99Dumra pana 04 26.67 02 13.34 06 19.99Madhyapana 01 06.67 02 13.34 03 09.99 87Total 15 15 30Table no.35 Showing Sthoola Cases in both Groups per Rasa preferred:Rasa Group A % Group B % Total %Madhura 14 93.34 12 80.00 26 86.67Amla 09 60.00 05 33.34 14 46.67Katu 07 46.67 11 73.34 18 59.99Total 15 15 30Table no.36 Showing Distribution of Sthoulya Cases in Group A and Baccording to “Nidra kala”:Nidra kala in hrs Gr A % Gr B % Total %10 or more 09 60.00 10 66.67 19 63.34Less than 10 06 40.00 05 33.33 11 36.66Total 15 15 30 Effect of Udvarthana in Sthoulya
  • Observation & ResultsTable no.37 Showing Distribution of Sthoulya Cases in Group A and B as perAdhyatana Agni:Adyatan agni Group A % Group B % Total %Pravara 15 100 13 86.67 28 93.34Madhyama 00 00.00 02 13.33 02 06.66Avara 00 00.00 00 00.00 00 00.00Total 15 15 30Table no.38 Showing Distribution of Sthoulya Cases in Group A and B as perPoorvagni: Poorvagni Group A % Group B % Total % Pravara 08 53.34 14 93.33 22 73.34 Madhyama 07 46.66 01 06.67 08 26.66 Avara 00 00.00 00 00.00 00 00.00 Total 15 15 30 88Table no.39 Showing Distribution of Sthoulya Cases in Group A and B as perAbhyahvarana shakthi:Abhyavaran Group % Group % Total %Shakthi A BUttama 12 80.00 13 86.67 25 83.34Madhyama 03 20.00 02 13.33 05 16.66Hina 00 00.00 00 00.00 00 00.00Total 15 15 30Table no.40 Showing Sthoola in both Groups as per Jarana shakthi Jarana Shakthi Group A % Group B % Total % Uttama 14 93.34 12 80.00 26 86.67 Madhyama 01 06.66 03 20.00 04 13.33 Hina 00 00.00 00 00.00 00 00.00 Total 15 15 30 Effect of Udvarthana in Sthoulya
  • Observation & ResultsTable no.41 Showing Distribution of Sthoola in both Groups as per Jatha Desha:Jatha Desha GroupA % Group B % Total %Anupa 01 06.66 01 06.66 02 6.66Sadarana 01 06.66 00 00.00 01 3.34Jangala 01 06.66 03 20.00 04 13.34anupasadarana 05 33.35 06 40.00 11 36.66jangalasadaran 07 46.67 05 33.34 12 40.00Total 15 15 30Table no.42 Showing Sthoola in both Groups as per Samvrudha Desha:Samvrudha Group % Group % Total %Desha A BAnupa 02 13.34 03 20.00 05 16.66Sadarana 01 06.66 04 26.66 05 16.66Jangala 02 13.34 02 13.34 04 13.34Anupasadarana 05 33.33 03 20.00 08 26.67Jangalasadaran 05 33.33 03 20.00 08 26.67Total 15 15 30 89Table no.43 Showing Distribution of Sthoulya Cases in Group A and B as perVyadhitha Desha:Vyadhita Desha Group A % Group B % Total %Anupa 01 06.66 02 13.34 03 10.0Sadarana 02 13.34 01 06.66 03 10.0Jangala 01 06.66 02 13.34 03 10.0Anupasadarana 05 33.34 07 46.66 12 40.0Jangalasadaran 06 40.00 03 20.00 09 30.0Total 15 15 30 Effect of Udvarthana in Sthoulya
  • Observation & ResultsTable no.44 Showing Distribution of Sthoulya Cases in Group A and B as perBody frame:Frame Group A % Group B % Total %Small 02 13.33 01 06.67 03 10.00Medium 13 86.67 14 93.33 27 90.00Large 00 00.00 00 00.00 00 00.00Total 15 15 30Table no.45 Showing Distribution of Sthoulya Cases in Group A and B as perEducational status:Education Group A % Group B % Total %Illiterate 00 00.00 00 00.00 00 00.00Below 10th 07 46.66 05 33.34 12 40.00Degree or below 06 40.00 07 46.66 13 43.34Post graduation 02 13.34 03 20.00 05 16.66Total 15 15 30 90Table no.46 Showing Distribution of Sthoulya Cases in Group A and B as perAssociated Features:Associated Group % Group % Total %Features A BPipasa 12 80.00 11 73.33 23 76.67Kshuda 14 93.33 15 100 29 96.66Swasa 07 46.66 12 80.00 19 63.33Dourgandhya 08 53.33 09 60.00 17 56.66Athi Sweda 12 80.00 13 86.00 25 83.33Srama 05 33.33 09 60.00 14 46.66Athi Nidra 12 80.00 09 60.00 21 70.00Kruchravyavaya 00 00.00 00 00 00.00 Effect of Udvarthana in Sthoulya
  • Observation & ResultsTable no.47 Showing Distribution of Sthoulya Cases in Group A and B as per Vihara:Vihara Group A % Group B % Total %Jagara 05 33.34 06 40.00 11 36.67Vyayama 03 20.00 04 26.67 07 23.34Avyayama 11 73.34 11 73.34 22 73.34Divaswapna 09 60.00 08 53.34 17 56.67Sukhashayya 13 86.67 13 86.67 26 86.67Chestadwesha 13 86.67 09 60.00 22 73.34Achintana 09 60.00 11 73.34 20 66.67Harshanitya 11 73.34 10 66.66 21 70.00 ResultsAssessment of subjective criteria in subjects of both the groups:(Please refer clinical study chapter for grading) 91I) Table no.48 showing the changes in chala spik, sthana and udara lambanabefore and after treatment in both the groups:Response Difference in grades Group A % Group B %Nil 0 13 86.66 09 60.00Mild 1 02 13.34 06 40.00Moderate 2 00 00.00 00 00.00Good 3 00 00.00 00 00.00 86.66% of group A subjects showed no change in above lakshana, whereas in group B 40% (6 pts) had improved.II) Table no.49 showing the changes Ayathaupachaya utsaha hani before andafter treatment in both the groups:Response Difference in grades Group A % Group B %Nil 0 06 40.00 06 40.00Mild 1 09 60.00 06 40.00Moderate 2 00 00.00 03 20.00Good 3 00 00.00 00 00.00 Effect of Udvarthana in Sthoulya
  • Observation & Results 9 patients in group A had mild improvement in symptom“Ayathaupachaya utsaha hani”. In group B 60%(12 pts) of subjects showedimprovement and 3 patients were not responded for this associated feature.III) Table no.50 showing the changes in Swedadhikyata before and aftertreatment:Response Difference in grades Group A % Group B %Nil 0 15 100 14 93.34Mild 1 00 00.00 01 06.66Moderate 2 00 00.00 00 00.00Good 3 00 00.00 00 00.00 There was no change in Swedadhikyata among the patients of group A.Only one subject had showed mild improvement in group B.IV) Table no.51 showing the changes in Ayase Swasa before and after treatmentin both the groups:Response Difference in grades Group A % Group B % 92Nil 0 13 86.66 10 66.66Mild 1 02 13.34 04 26.68Moderate 2 00 00.00 01 06.66Good 3 00 00.00 00 00.00 Only 2 patients had mild response for Ayase Swasa in group A and 5patients responded for the same in group B.V) Table no.52 showing the changes in Nidradhikya before and after treatmentin both the groups:Response Difference in grades Group A % Group B %Nil 0 03 20.00 03 20.00Mild 1 10 66.66 08 53.32Moderate 2 02 13.34 04 26.68Good 3 00 00.00 00 00.00 In both the groups, 6 patients did not respond for nidradhikyata. Rest ofthe 24 (12 in both groups) patients responded in the course of treatment. Effect of Udvarthana in Sthoulya
  • Observation & ResultsVI) Table no.53 showing the changes in Adhika Kshuda before and aftertreatment in both the groups:Response Difference in grades Group A % Group B %Nil 0 10 66.66 08 53.34Mild 1 05 33.34 06 40.00Moderate 2 00 00.00 01 06.66Good 3 00 00.00 00 00.00 66.66% of group A patients remained unchanged for Adhika Kshudawhere as in group B 46.66% (7 patients) had improved.VII) Table no.54 showing the changes in Ahara matra before and after treatmentin both the groups:Response Difference in grades Group A % Group B %Nil 0 00 00.00 01 06.66Mild 1 11 73.34 08 53.34Moderate 2 04 26.66 06 40.00 93Good 3 00 00.00 00 00.00 All of 15 patients showed improvement in group A and in group B 40%of subjects improved moderately with respect to their ahara matra.VIII) Table no.55 showing the changes in Ahara kala before and after treatmentin both the groups:Response Difference in grades Group A % Group B %Nil 0 00 00.00 00 00.00Mild 1 00 00.00 04 26.67Moderate 2 15 100.0 07 46.66Good 3 00 00.00 04 26.67 Effect of Udvarthana in Sthoulya
  • Observation & ResultsIX) Table no.56 showing the changes in Athi Pipasa before and after treatmentin both the groups:Response Difference in grades Group A % Group B %Nil 0 10 66.66 11 73.34Mild 1 05 33.34 04 26.66Moderate 2 00 00.00 00 00.00Good 3 00 00.00 00 00.00 For 5 patients Athi pipasa was revealed and in group B 73.34% ofsubjects showed no change.X) Table no.57 showing the changes in Kshuda sahatva before and aftertreatment in both the groups:Response Difference in grades Group A % Group B %Nil 0 00 00.00 00 00.00Mild 1 07 46.66 05 33.34Moderate 2 08 53.34 09 60.00 94Good 3 00 00.00 01 06.66 8 patients were moderately improved for Kshuda sahatva in control groupand 60.00% (9 pts) of group B subjects had same change in group B.XI) Table no.58 showing the changes in kshuda souhitya before and aftertreatment in both the groups:Response Difference in grades Group A % Group B %Nil 0 03 20.00 00 00.00Mild 1 09 60.00 01 06.66Moderate 2 03 20.00 12 80.00Good 3 00 00.00 02 13.34 Effect of Udvarthana in Sthoulya
  • Observation & ResultsXII) Table no.59 showing the changes in Alpa vyayama before and aftertreatment in both the groups:Response Difference in grades Group A % Group B %Nil 0 00 00.00 00 00.00Mild 1 14 93.34 07 46.66Moderate 2 01 06.66 08 53.34Good 3 00 00.00 00 00.00 93.34% of subjects in group A had mildly changed their alpa vyayamapravruthi, where as in group B 53.34% patients moderately improved in theirvyayama pravruthi. As the patients in both the groups were sensitive towards reveling theirsexual attitude, hence it was not assessed.XIV) Table no.60 showing the changes in Anga gourava before and aftertreatment in both the groups:Response Difference in grades Group A % Group B % 95Nil 0 03 20.00 01 06.66Mild 1 11 73.34 06 40.00Moderate 2 01 06.66 08 53.34Good 3 00 00.00 00 00.00 14 patients had relieved from Anga gourava in group B and in group Aonly 3 (20%) patients remained unchanged.XV) Table no.61 showing the changes in Anga sithilatha before and aftertreatment in both the groups:Response Difference in grades Group A % Group B %Nil 0 12 80.00 07 46.66Mild 1 03 20.00 08 53.34Moderate 2 00 00.00 00 00.00Good 3 00 00.00 00 00.00 Effect of Udvarthana in Sthoulya
  • Observation & Results There was no change in anga sithilatha among 12 patients in group A and7 patients in group B.XVI) Table no.62 showing the changes in Gatra sada before and aftertreatment in both the groups:Response Difference in grades Group A % Group B %Nil 0 08 53.34 05 33.34Mild 1 07 46.66 10 66.66Moderate 2 00 00.00 00 00.00Good 3 00 00.00 00 00.00 8 patients in group A and 5 patients in group B showed no response withrespect to Gatra sada. But 66.66% (10) patients in group B showed mild change.Table no.63 showing Subjective assessment (please refer assessment chart fornumbers) statistical analysis: 96** = Highly significant * = Statistically significant+ = Significant ++ = Insignificant Subjective parameter Gp I II III IV V Mean BT A 1.53 1.93 1.13 1.33 2.53 B 1.80 2.06 1.26 1.46 2.40 Mean AT A 1.40 1.33 1.13 1.20 1.60 B 1.40 1.26 1.20 1.06 1.33 Mean dif. A 0.133 0.60 00 0.133 0.933 B 0.40 0.80 0.06 0.40 1.066 Mean % of A 8.49 31.08 00 9.77 36.75 Improvement B 22.22 38.83 4.76 27.39 44.16 S.D  A 0.339 0.489 0.0 0.339 0.573 B 0.489 0.748 0.249 0.611 0.679 S.E  A 0.087 0.126 0.00 0.087 0.147 B 0.123 0.193 0.064 0.157 0.175 “t” valve A 1.519 4.754 00 1.528 6.349 B 3.252 4.142 1.028 2.536 6.081 “p” value A < 0.2++ <0.001** 1++ <0.2++ <0.001** B <0.010* <0.001** <0.4++ <0.02+ <0.001** Effect of Udvarthana in Sthoulya
  • Observation & Results Subjective parameter Gp VI VII VIII IX XMean BT A 1.93 2.66 2.66 2.73 2.8 B 1.66 2.60 2.60 2.73 2.60Mean AT A 1.60 1.40 0.66 1.00 1.26 B 1.13 1.26 0.60 0.56 0.86Mean dif. A 0.33 1.26 2.00 1.60 1.53 B 0.53 1.33 2.00 2.06 1.73Mean % of A 17.09 47.36 75.18 58.60 54.64Improvement B 31.92 51.15 76.92 75.54 51.15S.D  A 0.471 0.442 0.00 0.489 0.570 B 0.618 0.596 0.730 0.470 0.573S.E  A 0.121 0.114 0.00 0.126 0.147 B 0.157 0.153 0.188 0.121 0.147“t” valve A 2.738 11.09 0.00 12.698 10.428 B 3.394 8.667 10.615 17.074 11.717“p” value A < 0.025+ <0.001** 1++ <0.001** < 0.001** B <0.005+ < 0.001** <0.001** < 0.001** < 0.001** Subjective parameter Gp XI XII XIV XV XVI 97Mean BT A 2.20 2.06 1.80 2.20 1.33 B 2.13 2.13 2.13 2.40 1.53Mean AT A 1.86 1.00 0.93 2.00 0.93 B 1.86 0.60 0.66 1.80 0.86Mean dif. A 0.33 1.06 0.86 0.20 0.46 B 0.26 1.53 1.46 0.53 0.66Mean % of A 13.63 51.45 47.77 9.09 34.58Improvement B 12.20 71.83 68.54 22.08 43.13S.D  A 0.471 0.249 0.498 0.40 0.498 B 0.442 0.498 0.618 0.498 0.491S.E  A 0.121 0.064 0.128 0.103 0.128 B 0.114 0.123 0.159 0.128 0.126“t” valve A 2.738 16.656 6.739 1.937 3.626 B 2.331 12.463 9.185 4.147 5.285“p” value A < 0.025* <0.001** < 0.001** < 0.1+ < 0.005* B < 0.025* < 0.001** < 0.001** <0.001** < 0.001** Effect of Udvarthana in Sthoulya
  • Observation & ResultsAssessment of objective criteria:Table no.64 showing changes of weight in both Groups:S.No. Group A Group B BT AT Dif. BT AT Dif.1 90 88 2 99 94 52 66 65 1 83 77 63 89 88 1 60 58 24 85 85 0 76 75.5 1.55 90 89 1 92.5 88 4.56 87 86 1 71 65.5 5.57 81 81 0 91 86 48 80 78.5 1.5 90 87.5 2.59 75 74 1 86 82 410 94 91.5 2.5 90 85 511 79 79 0 86 82 412 78 76.5 1.5 95 92 313 70 68 2 96 93 314 93 91 2 70 65.5 4.515 69 68 1 78 72 6Total 1226 1208.5 17.5 1263.5 1203 60.5 98Table no 65 showing response of weight in both groups:Weight reduction Response Group A % Group B %0-2 kg Poor 15 100 03 20.003-5 kg Moderate 00 00 10 66.666-8 kg Good 00 00 02 13.34 There was maximum of 2.5 and 6 kg difference in group A and Brespectively. 80% of subjects in group B had lost weight of more than 2 kg. Effect of Udvarthana in Sthoulya
  • Observation & Results Chart- Showing changes of weight in both Groups: 7 Gr. A 6 Gr.B 5 4 reduction in kg 3 2 1 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15Table no.66 showing changes of BMI in both Groups:Pt.No. Group A Group B BT AT Dif. BT AT Dif.1 36.05 35.25 0.80 40.16 38.13 2.032 33.19 32.69 0.50 34.45 32.89 1.563 31.54 31.17 0.37 31.96 30.90 1.064 34.04 34.04 0.00 32.04 31.83 0.215 37.94 37.52 0.42 41.12 39.12 2.006 32.34 31.97 0.37 30.33 27.98 2.35 997 30.11 30.11 0.00 37.87 35.79 2.088 30.48 29.91 0.57 33.05 32.13 0.929 30.04 29.64 0.40 36.24 34.54 1.7010 36.26 35.29 0.97 31.14 29.41 1.7311 31.24 31.24 0.00 37.22 35.49 1.7312 32.47 31.84 0.63 32.87 31.83 1.0413 30.29 29.43 0.86 31.70 30.71 0.9914 35.43 34.67 0.76 30.17 27.61 2.5615 31.07 30.62 0.45 32.89 30.35 2.54Total 492.49 485.39 7.10 513.21 488.71 24.5Table no.67showing response of BMI in both groups:Changes in BMI Response Group A % Group B %No change Poor 03 20.00 00 00<1 Moderate 12 80.00 03 20.00>1 Good 00 00.00 12 80.00 Effect of Udvarthana in Sthoulya
  • Observation & Results0.97 was maximum reduction of BMI in group A and in group B 2.56. The leastreduction in group B is 0.21. In group A 80% of subjects reduced <1 BMI and ingroup B 80% patients reduction in >1 BMI. Chart- Showing changes of BMI in both Groups: 3 2.5 2 decrease in 1.5 BMI 1 0.5 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 pts Gr.A. Gr.B 100 Effect of Udvarthana in Sthoulya
  • Observation & ResultsTable no.68 showing Statistical analysis of weight and BMI after treatment inboth groups: Group Weight BMIMean BT A 81.73 32.83 B 84.23 34.21Mean AT1 A 80.56 32.35 B 80.20 32.58Mean AT2 A 79.13 31.78 B 78.03 31.76Mean dif.1 A 1.16 0.47 B 4.03 1.63Mean dif.2 A 2.60 1.04 B 6.26 2.45Mean % of A 1.41 1.43Improvement1 B 4.78 4.76Mean % of A 3.181 3.167Improvement2 B 7.43 7.132S.D1  A 0.745 0.296 B 1.347 0.650S.D2  A 1.26 0.496 B 2.143 0.775 101S.E1  A 0.192 0.076 B 0.3477 0.167S.E2  A 0.324 0.270 B 0.553 0.631“t” valve1 A 6.223 6.223 B 9.778 9.778“t” valve2 A 8.024 3.844 B 11.33 3.879“p” value1 A < 0.001** < 0.001** B < 0.001** < 0.005*“p” value2 A < 0.001** < 0.005* B <0.001** < 0.005*** = Highly significant * = Statistically significant+ = Significant ++ = Insignificant In above table, all parameters with “1” denotes value after 8 days oftreatment and “2” denotes value after one month of follow up. Effect of Udvarthana in Sthoulya
  • Observation & ResultsTable no.69 showing the response of both groups in chest circumference:Response Changes in centimeters Group A % Group B %Nil 0 13 86.66 00 00.00Mild 1 02 13.34 08 53.34Moderate 2 00 00.00 03 19.99Good >2 00 00.00 04 26.67 2 patients in group B showed maximum decrease of 2 cms in chestcircumference.Table no.70 showing the response of both groups in abdomen circumference:Response Changes in cm Group A % Group B %Nil 0 05 33.33 01 06.67Mild 1 08 53.33 03 19.99Moderate 2 02 13.34 01 06.67Good >2 00 00.00 10 66.67 102 Patients of group B had responded well in decrease of abdomencircumference. Maximum of 7 cms decrease was noticed in that group.Table no.71 showing the response of both groups in hip circumference:Response Changes cms Group A % Group B %Nil 0 06 40.00 03 20.00Mild 1 09 60.00 03 20.00Moderate 2 00 00.00 05 33.34Good >2 00 00.00 04 26.66 There was good response in decrease of hip circumference in patients ofB group. Maximum decrease of 4 cms was noticed in one patient of group B Effect of Udvarthana in Sthoulya
  • Observation & ResultsTable no.72 showing the response of both groups in Mid-arm circumference: Response Changes in cms Group A % Group B % Nil 0 14 93.34 10 66.66 Mild 1 01 06.66 04 26.68 Moderate 2 00 00.00 01 06.66 Good >2 00 00.00 00 00.00 Group A showed no response in 14 patients, where as group B hadresponded relatively well. One patient had decrease of 2 cms in trail group.Table no.73 showing the response of both groups in Mid-thigh circumference: Response Changes in cms Group A % Group B % Nil 0 08 53.33 02 13.34 Mild 1 05 33.33 07 46.66 Moderate 2 02 13.34 02 13.34 Good >2 00 00.00 04 26.66 4 patients in group B had decreased their circumference of mid-thigh over2 cms. Maximum of 3.5 cms decreased was noticed in that group. 103Table no.74 showing Circumference of Chest, Abdomen, Hip, Mid-arm, Mid-thigh statistical analysis: Gr. Chest cir. Abd cir. Hip cir. Mid-arm Mid- cir thigh cirMean BT A 104.8 106.73 111.13 33.73 61.76 B 107.93 111 114.36 33.7 61.76Mean AT A 104.66 105.93 110.53 33.7 61.26 B 106.26 108.33 112.66 33.26 60.13Mean dif. A 0.13 0.80 0.60 0.03 0.56 B 1.80 3.20 1.76 0.43 1.60Mean % of A 0.12 0.74 0.53 0.08 0.90Improvement B 1.66 2.88 1.53 1.27 2.59S.D  A 0.339 0.652 0.489 0.124 0.703 B 0.909 1.973 1.195 0.654 1.254S.E  A 0.087 0.168 0.126 0.032 0.181 B 0.234 0.509 0.308 0.028 0.323“t” valve A 1.528 4.761 4.761 1.0312 3.127 B 7.692 6.286 5.733 15.464 4.953“p” value A < 0.2++ < 0.001** < 0.001** < 0.4++ < 0.01* B < 0.001** < 0.001** < 0.001** < 0.001** < 0.001** Effect of Udvarthana in Sthoulya
  • Observation & Results** = Highly significant * = Statistically significant+ = Significant ++ = InsignificantThe changes observed in lipid profile are as follows:Table no.75 showing the decrease in Total cholesterol level in both the groups:Response Level Group % Group % Total % in mg/dl A B PatientsMild 5-25 15 10 09 64.26 24 82.75 0Moderate 26-45 00 00 03 21.43 03 10.35Good 46-65 00 00 02 14.31 02 6.90Total 15 14 29 There was mild response in all the subjects of group A. only one patienthad increase of total cholesterol by 6.4 mg/dl in group B and 14.31% patientsshowed good response in that group. 104Chart- Showing changes in Total cholesterol: 70 Gr.A 60 Gr.B 50 40 mg/dl 30 20 10 0 -10 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 pts Effect of Udvarthana in Sthoulya
  • Observation & Results Table no.76 showing changes in Total cholesterol (in mg/dl): Pt.n Group-A Group-B o BT AT DIF BT AT DIF 1. 182.4 179.1 3.3 262.6 269 -6.4 2. 133.8 126.4 7.4 186 169 17 3. 138.9 135 3.9 234.7 190 44.7 4 160.4 160.3 0.1 280 254 26 5 161.8 155.1 6.7 170 152 18 6 219.0 210 9 252 190 62 7 200.7 196.7 4 205 194 11 8 221.7 210 11.7 225.5 209 16.5 9 206 200.7 5.3 142.6 132.9 9.7 10 215 210 5 176 160 16 11 178 169.1 8.9 181 147.4 33.6 12 234.7 215.1 19.6 226 170.6 55.4 13 165.8 163 2.8 176 159 17 14 167 165.3 1.7 152.1 142.6 9.5 15 271 262.5 8.5 215 200 15 Total 2856.2 2758.3 97.9 3084.5 2739.5 345 105High-density lipoprotein (HDL):Table no.78 showing increase of HDL level: Response Level Group % Group B % Total % in mg/dl A Mild 0-6 15 100 04 40 19 76.00 Moderate 7-13 00 00 03 30 03 12.00 Good 14-20 00 00 03 30 03 12.00 Total 15 10 25 All 15 patients showed mild response in group A where as only 10subjects showed increase in their HDL levels in group B, but 3 pateints hadresponded good in this group. Effect of Udvarthana in Sthoulya
  • Observation & ResultsChart- Showing changes in HDL: 20 Gr.A 15 Gr.B 10 5 mg/dl 0 -5 -10 -15 -20 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 pts Table no.77showing changes in HDL : Group-A Group-B BT AT DIF BT AT DIF 1. 28.2 28.5 -0.3 40.8 55 -14.5 2. 26.4 28.2 -1.8 60 48 12 3. 61.2 64.4 -3.2 42.6 50.8 -8.2 4 29.2 31.2 -2 63 75 -12 5 28.2 28.9 -0.5 39 44 -5 6 30.6 31.4 -0.8 48 55 -7 106 7 29 29.7 -0.7 44 60 -16 8 27.4 28.1 -0.7 45.5 52 -6.5 9 48 49.5 -1.5 38.7 33.2 5.5 10 42 45 -3 54 58 -4 11 37 38.1 -1.1 52 36.4 15.6 12 42.6 46.2 -3.6 32.4 30.4 2 13 42.6 46.5 -3.9 42 48 -6 14 38 39.1 -1.1 37.8 29.5 8.3 15 38 40.2 -2.2 42 49 -7 Effect of Udvarthana in Sthoulya
  • Observation & ResultsLow-density lipoprotein (LDL):Table no.80 showing decrease of LDL level:Response Levels in mg/dl Group A % Group B %Mild 0-25 15 100 09 60.00Moderate 26-50 00 00.00 04 26.67Good 51-75 00 00.00 02 13.33Total 15 15 All the 30 patients responded well for decrease in LDL levels. 40% ofgroup B patients decreased more than 25 mg/dl of LDL levels.Chart- Showing changes in LDL: 70 Gr.A 107 60 Gr.B 50 40 mg/dl 30 20 10 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 no.pts Effect of Udvarthana in Sthoulya
  • Observation & Results Table no.79 showing changes in LDL: Group-A Group-B BT AT DIF BT AT DIF 1. 120.3 117.2 3.1 198 187 11 2. 71 62.2 8.8 126 97 29 3. 54.2 48.58 5.62 175.1 120 55.1 4 119.1 117.2 1.9 185 150.6 34.4 5 106.4 87.16 19.24 110 87.6 22.4 6 161.7 151.6 10.1 177 108 69 7 136.5 133.82 2.68 129 101 28 8 152.1 139.88 12.22 153.8 129 24.8 9 136 130.02 5.98 91.6 87 4.6 10 141.6 134.54 7.06 98.8 81 7.8 11 123 113.26 9.74 106.9 93 13.9 12 175.1 152.00 23.1 100.6 98.8 1.8 13 103.4 96.96 6.44 116 72.2 43.8 14 110 107.22 2.78 96.4 95.5 0.9 15 185 174.88 10.12 141.6 124.2 17.4 Total 1895.4 1766.52 128.88 2005.8 1631.9 363.9 108Triglycerides:Table no.82 showing decrease of Triglycerides level: Response Level in mg/dl Group A % Group B % Mild ≤5 15 100 02 22.21 Moderate 6-20 00 00.00 05 55.55 Good ≥ 21 00 00.00 02 22.24 Total 15 09 Only 9 patients in group B had decreased their Triglycerides levels ingroup B, where as all 15 patients responded in group A. maximum of 23mg/dl ofdecrease was noticed in group B. Effect of Udvarthana in Sthoulya
  • Observation & ResultsChart- Showing changes in Triglycerides: 25 Gr.A 20 Gr.B 15 10 mg/dl 5 0 -5 -10 -15 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 ptsTable no.81 showing changes in Triglycerides: Group-A Group-B BT AT DIF BT AT DIF 1. 169.7 167 2.7 120 135 -15 2. 182.6 180 2.6 130 120 10 3. 113.9 110.1 3.8 85 96.2 -11.2 4 60.9 59.5 1.4 160 142 18 5 136.1 135.7 0.4 108 112 -4 109 6 135.7 134 1.7 135 139 -4 7 176.1 170.9 5.2 160 165 -5 8 211.2 210.1 1.1 131.9 110 21.9 9 108 105.9 2.1 61.9 60 1.9 10 157 152.3 4.7 116 105 11 11 90 88.7 1.3 110.9 93 17.9 12 85 84.5 0.5 415 397.5 17.5 13 99 97.7 1.3 90 94 -4 14 98 94.9 3.1 89.5 88.1 1.4 15 240 237.1 2.9 157 134 23 Total 2063.2 2028.4 34.8 2070.2 1990.8 79.4 Effect of Udvarthana in Sthoulya
  • Observation & ResultsTable no.83 showing lipid profile statistical analysis: Gp Total chol. HDL LDL TriglyceridesMean BT A 190.41 36.56 126.36 137.54 B 205.63 45.45 133.72 138.01Mean AT A 183.88 38.33 117.76 135.22 B 182.63 48.28 108.79 132.72Mean dif. A 6.53 -1.76 8.59 2.32 B 23.01 -2.83 24.26 5.29Mean % of A 3.42 % 4.81 % 6.8 % 1.58 %Improvement B 11.19 % 6.22 % 18.64 % 3.83 %S.D  A 4.619 1.144 5.826 1.394 B 18.48 11.13 19.17 11.562S.E  A 1.192 0.295 1.504 0.359 B 4.771 2.87 4.949 2.985“t” valve A 5.474 5.966 5.712 6.462 B 4.822 0.994 4.902 1.773“p” value A < 0.001** < 0.001** < 0.001** < 0.001** B < 0.001** < 0.4++ < 0.001** <0.1++** = Highly significant * = Statistically significant+ = Significant ++ = Insignificant 110 Effect of Udvarthana in Sthoulya
  • Observation & Results Survey Study A survey was conducted during August and September month of 2003 tosee the incidence rate of obesity in the adult patient attending S.D.M collegeHospital for first time irrespective of their complaints. A total of five hundredand sixteen patients were studied with respect to their age, sex, religion,occupation, diet, height, weight and B.M.I. Out of total patients one hundred andninety three were having B.M.I. above 25 (irrespective of sex) the data ispresented as follows:Table no.84 showing Age wise distribution:Age Group Over all patients % No. of obese patients %18-30 168 32.58 67 34.8431-40 110 21.32 41 21.3241-50 120 23.24 52 27.0451-60 065 12.61 26 13.4261-70 037 07.16 05 02.3471-80 015 02.91 02 01.0481-90 001 00.18 00 00.00 111Total 516 193Chart- Showing Age wise distribution 180 18-30 160 31-40 140 41-50 120 51-60 100 61-70 80 71-80 60 81-90 40 20 0 All pts obese Effect of Udvarthana in Sthoulya
  • Observation & ResultsTable no 85 showing sex wise distribution:Sex Over all patients % No. of obese patients %Male 287 55.62 084 43.52Female 229 44.38 109 56.48Total 516 193 sexwise distribution of obese patient 84 male 109 female Sexwise distribution of all patients 112 43% male female 57%Table no.86 showing religion wise distribution:Religion Over all patients % No. of obese patients %Hindu 484 93.79 179 92.76Muslim 028 05.43 013 06.73Christian 004 00.78 001 00.51Total 516 193 Effect of Udvarthana in Sthoulya
  • Observation & Results Chart- Showing religion wise distribution: 500 484 450 400 350 300 HINDU MUSLIM 250 CHIRSTIAN 200 179 150 100 50 28 4 13 1 0Table no.87 showing Nature of work wise distribution:Nature of work Over all % No. of obese % patients patientsSedentary 308 59.75 136 70.47Moderate 103 19.40 051 26.42 113Hard 105 20.85 006 03.11Total 516 193Chart- Showing Nature of work wise distribution 350 300 Sedantary Moderate 250 Hard 200 150 100 50 0 All pts Obese Effect of Udvarthana in Sthoulya
  • Observation & ResultsTable no.88 showing Diet wise distribution:Diet Over all % No. of obese patients % patientsVegetarian 197 38.19 67 34.71Irregular mixed 046 08.91 23 11.92Regular mixed 273 52.90 103 53.37Total 516 193Chart- Showing Diet wise distribution All patients 38% 53% 9% vegetarian irregular mixed regular mixed 114 Obese patients 35% 53% 12% vegetarian irregular mixed regular mixed Effect of Udvarthana in Sthoulya
  • Observation & ResultsTable no.89 showing Height wise distribution: Height Over all patients % No. of obese patients % in cms 130-140 002 00.39 00 00.00 141-150 080 15.51 41 21.24 151-160 168 32.45 74 38.34 161-170 177 34.31 59 30.57 171-180 085 16.57 19 09.85 181-190 004 00.77 00 00.00 Total 516 193Chart- Showing Height wise distribution 180 131-140 160 141-150 140 151-160 120 161-170 100 171-180 80 181-190 60 40 115 20 0 All pts obeseTable no.90 showing Weight wise distribution: Weight Over all patients % No. of obese patients % in Kg 30-40 32 06.20 00 00.00 41-50 109 21.14 00 00.00 51-60 148 28.71 06 03.10 61-70 138 26.77 98 50.78 71-80 053 10.28 53 27.46 81-90 024 04.58 24 12.44 91-100 010 01.94 10 05.18 101-110 002 00.38 02 01.04 Total 516 193 Effect of Udvarthana in Sthoulya
  • Observation & ResultsChart- Showing Weight wise distribution 31-40 41-50 51-60 61-70 71-80 81-90 91-100 101-110 160 140 120 100 80 60 40 20 0 All pts obeseTable no.91 showing B.M.I wise distribution:B.M.I Over all patients % No. of obese patients %10-14 003 00.58 - -15-19 106 20.58 - -20-24 214 41.45 - -25-29 136 26.34 136 70.58 11630-34 044 08.53 044 22.7435-39 011 02.13 011 05.6440-44 002 00.39 002 01.04Total 516 193 Chart- Showing B.M.I wise distribution: 250 10-14. 200 15-19 20-24 150 25-29 100 30-34 35-39 50 40-44 0 All pts obese Effect of Udvarthana in Sthoulya
  • Discussion For every research work, rational interpretation and useful discussionshould be made, so that it contributes at least “squirrel service” to the medicalfield, inturn serving the society. Here an attempt is made to discuss the conceptswith respect to literary as well as on clinical work. Discussion on review of literatureDiscussion on definition of Sthoulya: All the definitions, which are mentioned in contemporary science, haveone or the other drawback. For instance, a person accustomed with regularexercises, may weigh relatively more and as per the definitions he should betermed as obese person inspite of his active routine works and lack of symptomsand hence one feels difficult to define obesity. But the definition given byAyurveda holds good in this regard. i.e. unless until irrespective of body weightif a person have “Chala Spik sthana and Udara lambana” he cannot be termed asobese. More over excess of fat is threat to life rather than weight alone. Henceassessment of fat is important and for that instead of measuring it in terms of 110laboratory parameters and calculations, it is better to stick on to the definition asmentioned in the classics for the diagnosis of the disease, however to grade andto assess the results one can take the help of BMI calculations.Discussion on synonyms: Various synonyms had been given in the ancient textbooks for Sthoulya,which includes from over weight to morbid obesity. Recent scholars had tried toclassify the synonyms based on modern criteria as follows:Table n0.92- Synonym of Sthoulya with modern interpretation: Synonym CommentBMI < 27 Pusti, mamsalata, piñata Well nourished deposition of fat with mild degree of overweightBMI 27-30 Medasvita, Medovridhi, For extensive growth of Meda dhatu Medurata, Medopusti without risk factor.BMI> 30 Athi Sthoulya, Medo vikara, Morbid obesity Medodosha, MedodustiWHR > 0.9 Tundika, Mahodara, Sthulodara Android obesity Effect of Udvarthana in Sthoulya
  • DiscussionDiscussion on physiological consideration of Meda Dhatu: There is very thin line difference between Medo vridhi and Meda roga.Many a times both of these terms are used synonymously. The only differenceone can find is that Meda vridhi person will have lambana of Spik, Sthana andUdara, where as Meda rogi will have Chalatwa due to increased lambana in thesame parts. It is very difficult to understand the concept of dhatu pramana. Hence 2Anjali of Medas is very difficult to correlate with any of the modernPhysiological entities. Sweda is said to be the excretory product of Medas, and it is practicallyseen in all most all subjects suffering with obesity will have excessive sweating. Vrikka and vapavaha are the moola sthana of Medas. It is described incontemporary literature that Triglycerides are stored around kidneys andomentum (about 25%). This shows that ancient scholars had an idea aboutmicroelements also. In classics ‘Vrukka’ is found intimately related with fat andattributed the acquiring of fat to it. “Vrukkwo pustikaro proktho jatarasya 111medasa”. By the reference available, it is found to be placed on either side of thebody, apparently inside the abdomen and fat originates from it which appears toresemble the supra renal glands. With regard to the medodhatu, it is necessary tolook into the action of a hormone produced by the adrenal gland on the fatmetabolism. Cortisol, a glucocorticosteroid produced by the cortex of theadrenal gland causes a moderate degree of fatty acid mobilization from adiposetissue but persons with excess cortisol secretion frequently develop obesity.Discussion on Nidana: Role of Beeja dosha a having its own part in the manifestation of thedisease. However unless and until the combination of dosha-dushya-nidana takesplace, Sthoolata in the body is not seen. The etiological factors that are found in both the classics are almostsame. The concept of Santarpaka Ahara and Vihara, when viewed with modernscience, than it can be concluded that the nidana, which are explained, are Effect of Udvarthana in Sthoulya
  • Discussionnothing but the high caloric foods and sedentary life styles. For ex. If a personsleeps in afternoon then due to increased resting hours the calories will bespared, resulting in fat accumulation. Hence the day sleep is totallycontraindicated in all individuals (expect in greshma ritu) for the maintenance ofhealth. Usually obese patients will have inactiveness. The following cycleshows the reason for the same In activity Weight gain Reduced exercise Decreased tolerance fitnessDiscussion on Lakshana: 112Ayushohrasa – decreased life span: The life span of an obese person decrease proportionally with increase ofBMI. As a result it will be increase chances of inviting the dead fullcomplications like Stroke, IHD etc. Hence an obese person dies after meetingwith the complications.Javoparoda- hampering the movements: As the skeleton is not customized with bearing extra burden in the formof fat, there will be hampering of movements.Meda Vridhi in Spik, Sthana and Udara: Every cell is designed in such a way that it can store excess of energy andutilize it during starvation or relatively decrease supply of energy. Due toadvancement in modern technology most of the population will hardly sufferfrom non-availability of food due to natural causes. Hence there will be always Effect of Udvarthana in Sthoulya
  • Discussionpositive energy balance in the body to which our body is not programmed tomaintain this condition. This excess of energy, irrespective of its form likecarbohydrates, fats and proteins are mostly stored as fat in the adipose tissues.The deposition of these fats are mainly seen in anterior abdominal wall, flanks,chest and buttocks will give rise to increase of these structures and hence theabove condition.3. Athi kshuda / Pipasa: Usually obese patients will have impaired levels of leptine, which isresponsible to cause satiety. Moreover due to increased basal metabolic rate,obese patients have to consume more energy; hence they come across abovefeature.Discussion on Upadrava: Some of diseases like Prameha (Type II diabetes mellitus) & Vata vyadhi(CVA) can be seen complication of obesity. Here Vata vyadhi will be of avarana 113type.Discussion on Action of Udvartana: As it is mentioned that ambu is present in Meda dhatu, to flush to theexcess of ambu dhatu, which is present either intercellular or intracellular,purgation is given with Trivruth lehya. This removes the excess of water, whichrepresents excess weight in the body. There are five basic principles to bringdosha from shakha to kosta: Vrudha – increasing the dosha Vishyanda –liquefaction Pakat – due to the paka of dosha Srotomukha vishodanat – due to Shodana of sroto mukha Vayu nigraha – due to control over Vata Effect of Udvarthana in Sthoulya
  • Discussion Udvartana is having the gunas of Kapha – Meda vilayana property. Dueto ushna and teekshna guna of dravya and forceful massage effect on romakupa,the Veerya of drug enters into body through, there after it opens the mukha ofsiras, there by making paka of Kapha and Medas. Due to this, there will bedravatha Vrudhi of Kapha and Medas. Swedana, which is given afterUdvarthana will further makes paka of the same. It also makes swedapravrathana and due to Sweda karma, which is given after Udvarthana, acts asSthambhana, Gouragna and Sheetagna. When the Doshas enters kosta, via abovemethods, they should be flushed out of the body. To evacuate these vikruthaDosha and Dushya, purgation is given with Trivruth lehya after completion ofsevan days of Udvarthana therapy. By all of these nirharana of Vikruth Vata,Kapha, aap dhatu along with Medas will takes place ultimately resulting inLaghavata of Shareera.Mode of action of Udvarthana on lipids: As it is seen that Udvarthana is having good efficacy over lipid levels. 114The probable mode of action can be explained as follows: Due to increased friction to all the parts of the body, the Triglyceridespresent in the subcutaneous tissues will break down into fatty acids. These fattyacids are carried out to the liver due to the effect of centripetal massage, whichincrease circulation to internal organs for the conversation of these fatty acidsinto bile. As less caloric food is supplied along with heavy exercises, the bodyneeds more of energy to meet the same. In the absence of carbohydrate, fats areutilized for the purpose of energy production. The bile that is formed in liver, onthe day of purgation will be expelled out in excess. Hence the reabsorption of thebile will be decreased, inturn further utilizing the lipid which is circulating in theblood. Promotion of excretion of bile in the feces is used as one of the treatmentprinciple to treat Hyperlipidemia eg. Colestipol. Effect of Udvarthana in Sthoulya
  • DiscussionHere is the explanation for the various benefits of Udvarthana:Twak prasadakara: This beneficial effect of Udvarthana is used to increasebeauty. Improvement in the complexion is the best criteria to assess the cosmeticproperty. The colour of skin depends on level of melanocytes, blood circulatingbeneath the skin and carotinoids. Colour given to skin by blood is mainlydepends upon the quantity of haemoglobin. By performing Udvarthana, theamount of blood circulation beneath the skin increases due to friction. Due tothis change the cells of the skin are supplied with more oxygen, there bychanging the colour at least to some extant. In all 15 patients the investigator hadobserved no changes with respect to their skin colour, but if this procedure isconducted as a routine practices there are chances to prove above hypothesis.Anga sthirikarana (stability of the body): There will be increase in the fatcells either in number or in size or both in obese person. By performingUdvarthana these fat cells get lipolysed then the cells get shrunken causingcompactness. Thus one can appreciate the above benefit. 115Gourava hara (depletion of heaviness): Gourava is feature due to increase inKapha and Medas. Udvarthana enhances transport of Cholestrol from theperiphery to the liver. This cholesterol is utilized for formation of bile (bilesalts). Hence due to decrease of fat one feels lightness.Dourgandhya hara (removal of body odour): Dourgandhya is the resultant ofSweda, which is mala of Medas. Due to Udvarthana there will be decrease inMala of Medas, hence formation of excess sweat is reduced, resulting in abovebenefit.Tandra hara (removal of drowsiness): Tandra is due to tamo guna, which isincreased by vikrutha Kapha. Udvarthana will reduce Kapha, hence relievesTandra. All the patients who received Udvarthana got this benefit. Effect of Udvarthana in Sthoulya
  • DiscussionKandu hara (removal of itching): One of the reasons for Kandu is obstructionin the Swedavaha srotas. As Udvarthana clears the orifices of Sweda vaha srotasby its Sira mukha vishodhana guna, it reduces itching. Udvarthana choornacontains ingredients that have Kandu hara property like Sarshapa.Mala hara (removal of excretory products): In general, mala includesPureesha, Mootra and Sweda. Here the term mala indicates only Sweda. Swedais the mala, which is excreted through orifices of the skin by Udvarthana.Vata hara: In sthoulya, Medas and Kapha obstruct Vata. Udvarthana reducesKapha and Medas and there by normalizing the movement of Vata.Shukrada: Due to mandata of Medodhatwagni, the uttarotara poshana of dhatugets hampered. Udvarthana corrects Medodhatwagni and hence formation ofconsecutive dhatu takes place, there by increasing the level of last dhatu- Shukra. It is mentioned in the modern literature “fat binds the testosterone”. i.e. 116high levels of lipids in blood will decrease Testosterone. Udvarthana reducesthe cholesterol there by hindering the testosterone binding thus making moreavailability of testosterone.Twak mriduta (softness of skin): By performing the Udvarthana, expulsion ofdebris of dermis and epidermis take place due to friction. It also increases bloodcirculation to layers of skin, there by supplying maximum oxygen to the dermalcells. Hence softness of the skin is observed. Moreover massaging effect onsebaceous glands stimulates sebum production and there by brings softness andtexture to the skin.Discussion on Results:Discussion on subjective parameters: All the patients had responded for most of the subjective features. Overall fifteen parameters had been assessed. “Krucchra vyavaya” was not analyzed, Effect of Udvarthana in Sthoulya
  • Discussionas most of the patients were sensitive to reveal their sexual performance andtheir desire towards sex (more over most of the subjects were females and hadattained menopause). Some of the parameters like Chalatwa of Spik, Sthana andUdara, Swedadhikyata, Ayase swasa, Anga sithilatha were respondedsignificantly by the patients of group B than group A. This shows Udvarthana ishaving its efficacy over relieving associated features.Discussion on subjective parameters:On weight: Patients of both the groups had decreased weight with an average of 1.16 0.74 kg in group A and 4.03  1.347 kg in group B after completion oftreatment. The maximum decrease was 2.5 kg and 6 kg in group A and Brespectively. After one month of follow-up, average weight lose was 2.6  1.26kg in group A and 6.26  2.14 kg in group B with ‘t’ value of 8.024 (p<0.001) ingroup A and 11.33 (p<0.001) in group B. 117On BMI: In group A maximum decrease was 0.97 with average decrease of 0.47 0.29 which shows its high significance (p<0.001) after completion of treatment.In group B minmum decrease was 0.21 and maximum decrease was 2.56 with anaverage of 1.63  0.296 with ‘t’ value of 9.778 (p<0.001). After one month of follow-up the average decrease of BMI was 1.04 0.27 in group A and 2.45  0.775 in group B.On lipid profile: Lipid profile was done for the subjects of both the groups. Both the grouphad shown some or the changes in the values.Total cholesterol: All the 29 patients had decrease in cholesterol level except inone case where there was increase of 6.4 mg/dl. Effect of Udvarthana in Sthoulya
  • DiscussionIn Group A: All fifteen patients got decrease in their total cholesterol. Average decrease → 6.53  4.61 mg/dl Minimum decrease → 0.1 mg/dl Maximum decrease → 19.6 mg/dlIn Group B: Out of fifteen patients fourteen got decrease in their total cholesterol. Average decrease → 23.01  18.48 mg/dl. Minimum decrease → 11 mg/dl Maximum decrease → 62 mg/dl Only one patient has gained by 6.4 mg/dlBoth the groups had shown highly significant response over Total cholesterol.One patient in Udvarthana group inspite of following regular diet and exercisehad gain in this lipid. It was difficult to analyze the reason behind the same.HDL: There is mean increase in HDL by 1.76  1.144 mg/dl and 2.85  11.13 118mg/dl in group A and B respectively.In Group A Out of fifteen subjects all patients had increase in HDL levels. Maximum increase → 3.9 mg/dl Minimum increase → 0.3 mg/dlIn Group B Out of fifteen subjects ten patients had increase in HDL levels. Minimum increase → 4 mg/dl Maximum increase → 16 mg/dl Average increase → 8.62 mg/dl Out of fifteen subjects five patients had decrease in HDL levels Minimum decrease → 2 mg/dl Maximum decrease → 15.6mg/dl Average decrease → 8.68 mg/d Effect of Udvarthana in Sthoulya
  • DiscussionThe reason for decrease in HDL of 5 patients is not known.Group A showed highly significance (p<0.001) whereas group B showedinsignificance (p<0.4) in HDL increase. Further research works are required inthis regard.LDL: There was decrease in LDL levels in Group A & B with an average of8.59  5.826 mg/dl and 24.26  19.17 mg/dl respectively.In Group A: All the fifteen patients had decrease in their LDL levels Minimum decrease → 3.1 mg/dl Maximum decrease → 23.1 mg/dlIn Group B: All the fifteen patients had decrease in their LDL levels Minimum decrease → 0.9 mg/dl Maximum decrease → 69 mg/dlWhen the results of both the Groups were compared, there was considerable 119reduction of LDL level in experimental group with highly significance ‘p’ value(<0.001). Hence Udvarthana can be advised as treatment of choice in patientswith high LDL levels.Triglycerides: There was considerable variation in Triglycerides levels inGroup A and Group B.In Group A: All the 15 patients had decrease in Triglycerides level. Minimum decrease → 0.4 mg/dl Maximum decrease → 5.2 mg/dl Average decrease → 2.18  1.394 mg/dlIn Group B: Nine out of fifteen patients had decrease in their Triglycerides level. Minimum decrease → 1.4 mg/dl Maximum decrease → 23 mg/dl Effect of Udvarthana in Sthoulya
  • Discussion Six patients among 15 subjects had increase in Triglycerides level. Minimum increase → 4 mg/dl Maximum increase → 15 mg/dl Overall there was a decrease of 5.29  11.56 mg/dl in all 15 patients.Group A patients showed highly significance (p<0.001) where as group Ashowed insignificance (p<0.1) statistically. However considering overall results,it can be stated that Udvarthana had better action over lipid profile.Discussion on patients:Case – 1: A female Hindu patient, aged 35 years, was suffering from increasedweight since 9 years. She had associated features of Athi Pipasa, Athi kshudha,Swasa, Athi Nidra, and Srama. Family history reveals that her parents wereobese. There was no history of Hypertension, Diabetes mellitus and long-termuse of drugs. She was vegetarian and takes food 4 times in a day. She preferredcold drinks and Madhura Amla yukta ahara. Subject also revealed that she was 120habituated with Avyayama, Divaswapna, Sukha shayya, Chestadwesha andAchintana. She used to sleep for more than 10 hours in a day. Her Prakruthi wasanalyzed as Kapha Vataja with Medasara Lakshana. Her Agni status (poorva andadyatana) was in pravaravastha. She was born and brought-up in Anupa-Jangalaand diseased in Anupa-Sadharana Desha. Her B.P, pulse and other general features were within normal limits.Patient frame was medium with height of 158 cm and 90 kg of weight with BMI36.05 on the day of admission. She had been allocated to group A, where shetook Trivrith lehya on 1st day and passed 9 Vegas. From 2nd day, she starteddynamic exercise and physiotherapy along with prescribed diet chart. Her bodycircumference and lipid profile values were taken before and after treatment. On 9th day, changes were noticed in subjective parameters. There wasdecrease of Total cholesterol by 3.3mg/dl, increase in HDL by 0.3 mg/dl, LDLdecreased by 3.1mg/dl, and decrease in Triglycerides by 2.7 mg/dl. She reducedher body weight by 2 kg and BMI decreased by 0.08. There were no changes in Effect of Udvarthana in Sthoulya
  • DiscussionChest, Abdomen and Mid-arm circumference. But Hip and Mid-thighcircumference were reduced by 1 cm.Case – 2: A female Hindu patient, aged 38 years, was suffering from increasedweight since 10 years with positive family history. She had associated featuresof Athi Pipasa, Athi kshudha, Swasa, Athi Nidra, Athi Sweda and Srama. Therewas no history of long-term drug use, Hypertension and Diabetes mellitus. Sheused to take vegetarian diet for 4 times a day. She preferred fruit juice, colddrinks and Madhura Amla yukta ahara. Subject also revealed that she washabituated with Avyayama, Divaswapna, Sukha shayya, Chestadwesha andHarshanitya. Her Prakruthi was analyzed as Kapha Pittaja with MedasaraLakshana. Her Agni status (poorva and adhyatana) was in pravaravastha. Shewas born, brought-up and diseased in Anupa-Jangala Desha. Her B.P, pulse and other general features were normal. She was ofmedium frame with height of 155 cm and 91 kg of weight with BMI 37.87 on 121the day of admission. She had been allocated to group B, where she tookTrivruth lehya on 1st day and passed 7 Vegas. From 2nd day, she underwentUdvarthana treatment with Triphaladi choorna followed by Sarvanga bashpasweda with Dashamoola kwatha. After 7 days of Udvarthana, she was givenTrivruth lehya on last day of her hospital stay. She passed 6 Vegas. Snigdhatawas noticed in stools after first 3 Vegas. The patient was on low-calorie diet andperformed prescribed dynamic exercises and physiotherapy. Her bodycircumference and lipid profile values are taken before and after treatment. On 9th day, changes were noticed in subjective parameters. There wasdecrease of Total cholesterol by 11mg/dl, increase in HDL by 16mg/dl, LDLdecreased by 28 mg/dl, but there was increase in Triglycerides by 5 mg/dl. Shereduced her body weight by 5 kg and BMI showed reduction by 2.08. There wasdecrease of 1cm in chest, abdomen and hip circumference. No changes wereseen in Mid-arm and Mid-thigh circumference. Effect of Udvarthana in Sthoulya
  • Discussion Discussion on survey: A total number of 516 adult subjects were surveyed, who had attended theOPD of SDMCA & hospital Hassan for first time. The system of Hospital ismaintained in such away that every new patient after getting their registration,has to go to Screening room, from where they will be sent to different OPD withrespect to their complaints. But the old cases will not be in contact withscreening room on their follow up. Hence the investigator had decided to selectthe screening room for his survey study. The objective of the study was to assess the incidence rate of obesity inpatients attending the above-mentioned OPD irrespective of their complaints.BMI parameter was selected to assess the obese patients (BMI> 25). Hence withthe help of measuring tape (in cms) and weighing machine the height and weightwere noted. Few other vital data age, sex, religion, life styles and diet were notedwhich are helpful for analysis. The survey was done on 30 working days inbetween 16th August to 21st of September of 2003. There were total of 193 122obese out of 516 patients in the study. The following are the out come of thestudy.Discussion on Age: Out of 516 patients, 168 patients were belonging to age group between21-30 years and there was only 1 patient in the age group between 81-90. Thesedata show that the younger age group patients are more aware of their healthproblems. Out of 193 obese patients 67(34.84%) were belonging to the age group of21-30. As the population was more in that age group, hence the prevalence rateof obesity was more in the same. Effect of Udvarthana in Sthoulya
  • DiscussionDiscussion on sex: A total number of 287 (55.62%) males and 229(44.30%) females werepresent in the population, out of which obese patient were 84(43.52%) males and109(56.48%) females which reveals that females are more prevalent for obesity.Discussion on religion: Survey was done in Hindu dominated area; hence the number of Hinducases was more in the study. Out of 484 Hindu patients, 179(92.76%) wereobese.Discussion on life style: 308 patients were habituated to sedentary life styles, out of which 136patients (70.47%) had obesity. This shows that, sedentary type of life style havedefinite role in the causation of disease.Discussion on diet: 123 Out of 516 patients, 316(61.83%) were consuming mixed diet (includingregular and occasional non-veg diet). 53.37% of regular mixed diet (non-veg > 4times a month) and 11.92% of irregular mixed diet (<4 times a month) sufferedfrom obesity. This shows that non-vegetarian diet is one of the triggering factorsfor obesity, avoidance of which (except fish which contains omega 3 fatty acids)is believed to decrease BMI.Difficulties and limitation of the study: The major problem with the investigator was to allocate the patients intocontrol group. As the study was conducted in an Ayurvedic Hospital, the obesepatients attended the OPD, expecting some Ayurvedic remedy for their problem,but when they were asked to undergo purgation and Exercises along with dietmany patients agreed after proper convincement. Once they started realizing that Effect of Udvarthana in Sthoulya
  • Discussiontheir problem is due to sedentary life style with high calorie intake, they pleasedand actively participated in the study. However this problem was notexperienced in case of trail group patients, as many of the patients visit Hospitalrequesting to undergo Udvarthana. The second difficulty was monitoring the diet of patients. During theirstay at Hospital some how they managed with great enthusiasm, but when theylost their weight and after discharge patients were again attracted by sweets andsuch other obesity predisposing foods and activities. However, it wasinvestigators out of reach to observe each patient after discharge from Hospital. Many of the obese patients were attracted towards the products, which areexperimented in abroad, were brought to India to exploit the innocent citizens.Many of such products were telecasted right from local TV channels tointernational channels. Almost all magazine will publish one or the other suchproducts showing before and after treatment photos. Some of the patients in thestudy were undergone such products and met with adverse effects. It is theresponsible of the government to take strict action over such things and help the 124public for avoiding such mistakes. As the sample size was small, a pinpoint conclusion cannot be drawn.Hence it is suggested to conduct the same study over large samples. The followup period was restricted for one month keeping in view of study period. Infuture, the same study should be carried out to check the regain of weight for aconsiderable period.Further recommendation of study: 1. Same study on secondary obesity. 2. Continuation study with Yavamalaka choorna during follow-up. 3. Survey study in healthy population to assess its prevalence rate. Effect of Udvarthana in Sthoulya
  • Conclusion-summary The present study was carried out, giving importance to literary,diagnostic and therapeutic aspect considering the ancient as well ascontemporary views. The following conclusion along with summary is drawnafter considering the clinical and conceptual study. This study has done giving equal importance for conceptual as well asclinical aspects. One should agree the fact that the modern medicineadvanced a lot in this aspect in terms of assessment for weight as well as fatparameters. Inspite of that there are lacuna in some aspects like definingobesity, its treatment etc. The lipid in modern parlance is correlated to Medas with a thought thatMedaja upakrama can be adopted in treating lipid disorders. At the same timea brief review regarding the lipids and Hyperlipidemia was done. The Lakshana described in Ayurvedic literature are more worthwhile 125than the disease features explained in contemporary science. Ayurveda givesimportance to the bulk of the body; hence to assess the same one should takethe help of Anguli pramanas so as to assess the normal size of the body andto compare the same with increased bulk of diseased. The drugs that are described as Pathya for sthoola are rich source offibers and hence they can be used, so that patient feels the fullness ofstomach. Fibers stimulates satiety center. Classification done on nidana like Aharaja, Viharaja, Manasika and anyaholds good for sthoulya. Because each of them have its own role to play butabove all samanyaja stands first. If that is not in favour of sthoulya thandisease cannot manifest. Hence it can be concluded that it is theVikaravighatakara bhava. Effect of Udvarthana in Sthoulya
  • Conclusion-summary The degrees of obesity like mild, moderate and morbid can be correlatedwith vagbhatacharya’s classification like Avara, Madhyama and Pravara Sthoolarespectively. The concept behind explaining Sthoola as one among the Ashta Nindita ismainly due to symptoms like Ayushohrasa, complicated pathology and long-term management. Among genetic and environmental factors, it is very difficult to judge, whichis having a key role in the manifestation. In the survey study, some of obesecases reveal the family history and food that they consume, which are alsopredisposing factors that are commonly observed. Hence it is difficult to separatethese two entities. Exercise is having its own role to play in reducing and maintaining theweight. These patients should be advised to stay active through out the day and 126minimize some of the sedentary activities like watching television, using vehicleetc. They always require continuous encouragement and motivation to performphysical activities. Udvarthana should be practiced as a daily regime especially for obesepatients. In classics, it is described to perform Udvarthana after vyayama andbefore snana, but if it is done before vyayama then it will be helpful to utilize theperipheral fatty acids for energy, there by increasing the lipolytic action. Synonyms described in the text should be used as and when required insteadof using them in broader sense. For example to describe a person of mild obesitythe terms like Medasi, Medurata are suitable whereas to point out morbid obeseperson using the term like athi sthoulya etc. by doing so it will be helpful tochoose the therapy with quality and quantity of Pathya merely by looking at thediagnosed term. Effect of Udvarthana in Sthoulya
  • Conclusion-summary Some of the scholars make differential diagnosis of Sthoola person with thepatients of Sarvanga shotha and Udara, but thorough inspection itselfdifferentiates these conditions. Sthoulya is not just a physical weight burden but the patient also faces manypsychological problems right from wearing tight cloths till insult in the society. A clinical study was done on 30 patients. The patients were divided intotwo groups namely group A and group B and were advised to follow exerciseand prescribed diet for 1 week, before to which they had been given purgationwith Trivruth lehya. This was common for both the groups. Apart from thisgroup B underwent Udvarthana and purgation after complication of Udvarthana.Swedana was given after Udvarthana on every day. Lipid profile was donebefore and after treatment. Other objective parameters like weight, BMI andanthropometrics reading were considered. The associated features were alsograded and compared before and after treatment. The duration of the treatment 127was 9 days and after that the patients were asked for follow up after one month.The results (subjective and objective) were encouraging in trail group (B). Theobservation and results were tabulated and statistically analyzed with relevantparameters. With respect to reduction in weight, group A patients shown 1.16  0.74kg where as in group B 4.03  1.34 kg. Mean decrease of BMI was 0.47  0.29and 1.63  0.65 of BMI in group A and B respectively. The serum lipids had also responded well for the treatment. Totalcholesterol levels increased with an average of 6.53 and 23.01 mg/dl in A & Bgroups respectively. There was mean increase of HDL by 1.76 and 2.83 mg/dl,however in some cases the levels decreased in group B. LDL levels weredecreased by 8.6 and 24.93 mg/dl and Triglycerides also decreased by anaverage of 2.18 and 5.29 mg/dl in group A and B respectively. Over all thepatients of Udvarthana group responded well compared to the subjects of controlgroup. Effect of Udvarthana in Sthoulya
  • Conclusion-summary The patients also showed marked difference in body circumferencesespecially in abdominal circumference. Here also group B patients respondedwell than control group subjects. There was a relative improvement in subjectivecriteria in both groups. It can be concluded that Udvarthana is having significanteffect in Sthoulya. To know the incidence rate of obesity, a survey was conducted and it isdiscussed in observation chapter. After completion of study, it can be concluded that environmental factorsplays an important role in the causation of the disease and a holistic approach isrequired to tackle this multifactorial disease. Approach to an obese patient:History: ☻ Smoking habit 128 ☻ Current drug therapies that affect weight ☻ Alcohol intake ☻ Risk factors like angina, strokeExamination: ☻ BMI ☻ Waist circumference ☻ Blood pressurePsychological: ☻ Depression ☻ Eating disorderInvestigation: ☻ Lipid profile ☻ Thyroid hormone analysis ☻ Blood glucose Effect of Udvarthana in Sthoulya
  • Conclusion-summaryPrincipals of behavioral modification:Issues to be discussed in-group behavioral therapy are: Self-monitoring using a food diary Need for long-term life style change Need to modify eating habits Need to assess present exercises level and ideas to increase this if necessary Importance of restricting occasions and situation when inappropriate types or amounts of food are eaten Separation of eating from other activates Planning of daily food intake Understanding of food levels and adopting recipes with regard to fat, salt, sugar and fiber. Possibility of changes to individual eating style Identification of the causes of negative emotions and stress 129 Recognition that eating may be related to stress Need to self-monitor feeling and emotions Dealing with situations that interfere with every day food choices. Effect of Udvarthana in Sthoulya
  • List of reference:Review of literature- Sthoulya: 1. Bh. Pr. Madhyama 39 2. Ch. su.21/19 3. Su. su 35/34 4. Sha. Madhyama 7/68 5. Ka. khila 6. Ch. chi 15/35 7. Bh. Pr 8. Su. su 15/7 9. Pratyaksha Shareera pg-10 10. Su. sha 4/12 11. Su. sha 9/12 12. Ch. chi 15/18 13. Ch. chi 15/17 14. Ch. vi 8/106 15. Su. su 35/16 16. Su .su 15/14 17. As. Hr. su 11/11 18. Su. su 15/9 19. As. Hr .su 11/18 20. Ch. su. 23/3-6 21. Ma. Ni 31/1-2 22. Su. su 15/32 23. Ch. vi 5/15-16 130 24. Ch. ni 4/5 25. Ch. chi 6/4 26. Ch. vi 3/ 27. Ch. ni 4/4 28. Ch. chi 28/9 29. Ch. chi 11/12 30. Ch. chi 22/18 31. Ch. su 28/15 32. Ch. ni 4/8 33. Su. sha 9/12 34. As. Hr. ni 1/2 35. Ma. Ni 1/5 36. Su. su 15/32 37. Ch. su 21/4 38. As. Hr. su 11/10-11 39. Ch. vi 5/ 40. As. Hr. su 41. Ch. chi 21/40 42. Ch. su 21/5 43. Ch. su 10/8 44. Ch. su 10/10-13 45. As. Hr. su 14/31 46. Ch. chi 6/57 Effect of Udvarthana in Sthoulya
  • 47. Ch. su 23/8-13 48. Ch. su 21/16 49. Ch. su 21/15 50. Ch. su 21/10 51. Ch. su 25/40 52. Ch. su 21/17Review of literature- Obesity: 1. Essentials of Medical Physiology- K Shambhulingam 2. Principles of Anatomy and Physiology- Tortora & Grabowski 3. Textbook of Physiology – Guyton 4. Textbook of Preventive and Social Medicine – K Park 5. Textbook of Preventive and Social Medicine – Gupta & Mahajan 6. Harrison’s Principles of Internal Medicine 7. Pathologic Basis of Disease- Robbins 8. Clinical Medicine – Kumar & Clark 9. Physical Diagnosis – Vakil & Golwalla 10. Principles of Community Medicine – Sridhar Rao. 11. Principle and Practice of Medicine – Davidson 12. Clinical Dietetics & Nutrition – Antia & PhilipReview of literature- Udvarthana: 131 1. Ch. su 22/14 1a. Ch. su 22/14: chakrapani 2. Ra. vai.30/14 3. Ch. su 22/34-35 4. Su. ut. 39/104 5. As. San. su 24/12 6. As. Hr. su.14/17 7. Ch. su 22/37 8. Ch. su 21/13-14 9. Su. ut 39/105 10. As. Hr. su 14/18 11. As. San. su 21/16 12. Ch. su 22/41 13. Ch .su 16/7-8 14. Yo. Ra. ritucharya 15. As. Hr. su 3/19 16. Su. chi 24/54-56: Dalhana Effect of Udvarthana in Sthoulya
  • BibliographyBibliography 1. Agnivesha krita, Charaka-Drudabala pratisamskrita, Charaka Samhita with chakrapani datta virachita Ayurveda deepika vyakhya, published by Choukhambha samskrita Samsthana, Varanasi, 4th edition 1995, sutrasthana 21/21, page 117. 2. Sushrutha krita, Sushrutha samhita with Dalhana virachita Nibandha Sangraha vyakhya, published by Choukhambha orientalia, Varanasi, 6th edition 1997, sutrasthana 15/14 page 70, chikitsasthana 24/51 page 489. 3. Vagbhata krita Ashtanga Hridaya with Arunadatta virachita Sarvanga sundara vyakhya and Hemadri virachita Ayurveda Rasayana vyakhya, published by Krishnadas academy,Varanasi,1995,sutrasthana 2/15 page38. 4. Vriddha Vagbhata krita Ashtanga Sangraha with Indu virachita shashilekha vyakhya, published by Krishnadas academy, Varanasi, 1995, sutrasthana 15/ 5. Madhavakara krita Madhava Nidana with Vijayarakshita & Srikantadatta virachita Madhukosha vyakhya, published by Choukhambha samskrita Samsthana,Varanasi,20th edition 1993,vol II medoroga nidana page 28-30. 6. Chakrapanidatta krita Chakradatta (Chikitsa sara sangraha) with Shivadas sen virachita Tatwachandrika vyakhya, Published by Choukhambha orientalia, Varanasi, page 429. 7. Vangasena samhita edited by Shankarlal Harishankar, Published by Kaviraj Srikrishnadas, Bombay, page 498. 8. Anonymous- Yogaratnakara with Vidyotini Hindi vyakhya, Published by Choukhambha samskrita Samsthana, Varanasi, 6th edition 1997, Medoroga chikitsadhikara, uttarardha, page 98-108. 132 9. Bhavamishra krita Bhavaprakasha nighantu edited by Pandit sri Bramha Shankar Mishra,published by Choukhambha samskrita Samsthana, Varanasi 10. Raja nighantu edited by Giridayala Shukla, Published by Choukhambha samskrita Samsthana, Varanasi. 11. Basavarajeeyam uttarardha – Shivakaran Sharma, 1954, Rasayana Pharmacy Bhavan, Chennai. 12. Rasa Ratna Samucchaya Ambikadatta shastri, 1978, Choukhambha samskrita series, Varanasi. 13. Introduction to Kaya chikitsa by K. Dwarakanath, Published by Choukhambha orientalia, Varanasi. 14. Digestion and Metabolism in Ayurveda by C. Dwarakanath Published by Baidyanath Publication, Calcutta. 15. Concept of Agni in Ayurveda by C. Dwarakanath Published by Baidyanath Publication, Calcutta. 16. Nidana Chikitsa Hastamalaka by Ranajith Roy Desai, Published by Baidyanath Ayurveda Bhavan, Nagapur. 17. Dravya Guna Vignana by P.V.Sharma Published by Choukhambha orientalia, Varanasi. 18. Manier-williams A Sanskrit English Dictionary, Published by Sundarlal Jain, page 1266. 19. Researches in Ayurveda by M.S.Beghal, Published by Mridu Ayurvedic publication and sales, Jamnagar. 20. Indian Materia Medica by K.M.Nadakarni, Published by Popular Prakashan, Bombay, 2nd edition. Effect of Udvarthana in Sthoulya
  • Bibliography21. Ayurveda Encyclopedia by Swami Sadashiva Thirtha, Published by Indian book center, Delhi.22. Kaya chikitsa by Shivacharana Dhyani Published by Ayurveda and Tibba academy, vol II.23. Vaidya Pandita Hariprapanaji virachita Rasayoga sara Published by Krishanadas academy, Varanasi.24. Park’s Text Book of Preventive and Social Medicine by K.Park, 16th edition,2000,Published by Banarsidas Bhanot, Jabalpur, page 296 & 436.25. Text Book of Preventive and Social Medicine by MC Gupta & BK Mahajan, 3rd edition,2003, Published by Jaypee Bros New Delhi page 359.26. Review in Community Medicine by V.V.R.Seshu Babu, 2nd edition 1996, Paras Medical Books, Hyderabad.27. Principles of Community Medicine by Dr.B.Sridhar Rao, 3rd edition, 2002, Published by AITBS publishers and distributors, Delhi.28. Social and Preventive Medicine by Yash Pal Bedi, 15th edition, published by Atma Ram and sons, Delhi.29. Principles of anatomy and Physiology by GJ Tortora and SR Grabowski, 9th edition, 2000, published by John wiley and Sons INC. page 908.30. Physiology by Berne, Levy, Koeppen & Stanton, 5th edition, 2004, published by Missouri, page 946.31. API Text Book of Medicine edited by G S Sainani & co.6th edition 1999. Published by Association of Physicians of India, Bombay, page 208-210.32. Harrison’s Principles of Internal Medicine, edited by Braunwald,15th edition, 2001, published by Mcgrawhill Medical publishing division New Delhi, page 479-485. 13333. Davidson’s Principles and Practice of Medicine, edited by Cristopher R W Ewards 17th edition, 1995, published by ELBS with Churchill livingstone, page 578-584, 886-888.34. Robbins Pathologic Basis of Disease, by Cotran, Kumar & Robins, 5th edition, 1994, Published by W.B.Sounders & co. Bangalore, page 425-42735. Clinical Medicine by Praveen Kumar & Clark, 4th edition, 1999, Published by W.B.Sounders, page 207-210.36. Oxford Clinical Dietetics & Nutrition by F.P.Antia & Philip Abraham, 4th edition, 2002, pubished by oxford university press, page 176,336-346.37. Nutrition- A health promotion approach by Geoffrey P webb, 2nd edition, London.38. Grey’s Anatomy edited by Henry Gray, Peter L Williams, Laurence Bannister, 38th edition, 1995, Churchill livingstone, New York.39. Advanced Textbook on Food and Nutrition by Swaminathan M, The Bangalore Printing and Publishing co. ltd. Effect of Udvarthana in Sthoulya
  • Annexure Department of Post-Graduate studies in Swasthavritta, SDM College of Ayurveda, Hospital, Hassan.Clinical Trail: “Effect of Udvarthana in Sthoulya”Candidate: Dr.Prasanna Kumar.K M.D scholarGuide: Dr.Sajitha.K M.D (Ayu) HOD: Dr.Ramana.G.VM.D (Ayu)-------------------------------------------------------------------------------------------------------------------------------------------------------------- CASE SHEET PROFORMA FOR STHOULYAName of the patient: Date:Age: O.P. No:Occupation: I.P. No:Sex: Group:Religion: Clinical trail No:Marital status Date of admission:Socio Economic: Date of discharge: IEducation: Result:Occupation:Address:Pradhana vedana and avadhi:Anubandha vedana: Atipipasa / Atikshudha/ Dourgandhya / Swedabhada / Kasa/ Kshudrashwasa /Krantana / Atinidra / Kruchra Vyavaya / Moha / Shrama / Sandishoola /Others.Pradhana vedana vrittanta:Poorva vyadhi vrittanta:Ef Effect of Udvarthana in Sthoulya
  • AnnexureChikitsa vrittanta:Koutumbika vrittanta:Atura charya:Personal history:Bowel: Micturition:Habits: Exercise:Occupational history:Menstrual history:Dietic history:Appetite: Type of food:Quantity of food: Frequency of food intake:Preferred taste: Preferred fluids: IIVihara:Nidra kala:Type of Nidra:General condition:B.P: Pallor:Pulse: Edema:Cyanosis: Icterus:Swasa gathi: Dehoshma:Adyathana Agni: Poorva Agni:Abhyavara shakthi: Jarana shakthi:Ef Effect of Udvarthana in Sthoulya
  • AnnexureMala pravruthi: Mootra pravruthi:Jihwa: Lymph node:Prakrutyadi pareeksha:Prakruthi: Saara: Sareerika: Manasika:Samhanana Desha: Jatha/ samvrudha / vyadhitaPramanata:Height:Parameters Before treatment After treatmentWeight:BMI:Chest circumferenceAbdomen circumferenceHip circumferenceMid-arm circumference IIIMid-thigh circumferenceSatmaya: Satwa:Kala: Bala:Routine examination:Hair: Amount: Texture: Distribution:Skin: Texture: Moisture: Pigmentation:Face:Ef Effect of Udvarthana in Sthoulya
  • AnnexureEyes: Visual acuity: Exopthalmos: Retinopathy:Nose: Polyps: Nasal mucosa: Septum:Mouth: Lips: Tongue: Teeth: Gums: Buccal mucosa: Pharynx:Neck: JVP: Thyroid glands: Larynx: Trachea: Lymph glands: Movements: IVNails:Joints:Thorax:Upper limbs:Abdomen:Lower limbs:Neurological changes: Mental changes: Stupor: Tremor: Reflux:Ef Effect of Udvarthana in Sthoulya
  • AnnexureSYSTEMIC EXAMINATION(Including srotas pareeksha)Cardio vascular system:Respiratory system:Gastro-intestinal system:Nervous system:Locomotor system:Uro-genital system:Other systems: Srotas pareekshaPranavaha srotas: Udakavaha srotas:annavaha srotas: Rasavaha srotas:Raktavaha srotas: Mamsavaha srotas: VMedovaha srotas: Asthivaha srotas:Majjavaha srotas: Shukravaha srotas:Mutravaha srotas: Pureeshavaha srotas:Swedavaha srotas:Proyogalaya pareeksha: Blood for: TC, DC, ESR, Hb%, RBS, Lipid profile. Urine for: Sugar, Albumin, Micro.Lipid profile Before treatment After treatmentTotal cholesterolHDLLDLTriglyceridesEf Effect of Udvarthana in Sthoulya
  • AnnexureVIKRUTI PAREEKSHA:(1) Hetu: Beeja dosha: Ahara: Vihara: Manasika: Anya:(2) Poorvaroopa:(3) Roopa:(4) Upashayanupashaya:(5) Samprapti: Dosha samanya: vishesha: Dushya 1. Dhatu: 2. Upadhatu: 3. Mala: 4. Srotas: 5. Dustiprakara: VI 6. Agni: 7. Ojus: 8. Rogadhistana: 9. Roga marga: 10. Vyadhi prakara:(6) Sapeksha nidana:(7) Vyavachchedhaka nidana:VYADHI VINISCHAYA:Rogi bala:Roga bala:Upadrava:Ef Effect of Udvarthana in Sthoulya
  • AnnexureArista:Sadhyasadhyata:CHIKITSA:Group selected for the treatment: 1. Control group- A 2. Experimental group- BCHIKITSA KRAMA for group-A: OBSERVATIONS Day-1 Day: 2-8 Day-30 Purgation Exercises Follow-upSubjective parametersObjective parametersLaboratorialparametersCHIKITSA KRAMA for group-B: OBSERVATIONS Day-1 Day: 2-8 Day: 9 Day-30 VII Purgation Exercises Purgation Follow-up With Udvarthana Subjective parameters Objective parametersLaboratorialparametersPathya-Apathya:Pathya:Apathya:Signature of the Investigator Signature of the guideEf Effect of Udvarthana in Sthoulya
  • Annexure Department of Post-Graduate studies in Swasthavritta, SDM College of Ayurveda, Hospital, Hassan. Clinical Trail: “Effect of Udvarthana in Sthoulya” Diet chart for SthoolaMorning –7:00-7:30 AM: Honey with water / Punarpuli juice – 75 ml.9:00-10:00 AM: Breakfast: Vegetables salad- 100 gm + Sprouts-50 gm or 2 idly with chatni or 1 Dosa (oil less) with chatni or 1-cup upma11:30 AM: Carrot juice / Lemon juice- 200 mlNoon:1:00 – 2:00 PM: Lunch: 1-2 dry Chapatti / 1 Ragi ball / 1-2 Ragi roti + 1 small cup Rice with sambar + Unlimited raw / cooked vegetables4:00 – 5:00 PM: Buttermilk / Lemon juice- 200 mlNight:8:00 – 9:00 PM: VIII Dinner: 1-2 dry Chapatti / 1-2 Ragi rotti + Vegetable salads including cucumber, carrot, tomato, radish + buttermilk - 200 ml.General Instruction: If there is uncontrolled appetite in between meals then, carrot, cucumber, mosambi, orange, sprouts can be taken in moderate quantity. Avoid sweets, oily foods, ghee, curds, potato, banana, mango and other foods that contain more of carbohydrate. Avoid mutton, chicken, pork and other non-vegetarian foods except fish. Foods stuffs prepared of rice in moderate quantity. Avoid using coconut / ground nut oils and use refined oil for cooking. Avoid bakery items, chocolates, cold drinks, milk and milk products except buttermilk, alcohol. Perform exercises atleast for 1 hour / day, brisk walk, jogging, Yogasana Avoid day sleep, TV watching and such other sedentary works.Ef Effect of Udvarthana in Sthoulya
  • Annexure List of Dynamic exercises Jogging: Forward /Backward / Sideward Neck rotation Flexion and extension of all joints Twisting Bending: Forward / Backward / Sideward Toe touching Heal touching Hip rotation Knee rotation: Inward / Outward / Both Back swing Rocking and Rolling Lumbar stretch Alternate knee touching Straight leg raising Side leg arising Free walk Baby walk Camel walk Crow walk Step climbing Spinal twistTable no.93-Common Indian preparation with kilocalories of energy:Food Wt/serving kcal Food Wt/serving kcal IXpreparation in gm preparation in gmPlain rice 504 595 Idli (2) 136 130Sambar bath 485 405 Plain dosa(2) 100 216Curd bath 253 221 Masala dosa(1) 100 212Uppuma 128 163 Puri(2) 32 136Chappatis (2) 57 193 Parota (1) 66 304Ragi ball 336 446 Ragi roti (2) 185 460Jowar roti(2) 150 252 Bengal gramdal 151 284Tea 100 36 Coffee 100 52Meat curry 128 220 Fish fry 100 220Ef Effect of Udvarthana in Sthoulya
  • AnnexureTable no.94- showing activities and caloric burn with respect to different weight: APPROXIMATE CALORIE BURNED/ ACTIVITY HOUR IN DIFFERENT PERSONS 50 kg 60 kg 70 kg 80 kgCycling 20 miles/hour 990 1188 1386 1584Running 12min/mile 510 576 672 768Walk / jog – 10 min 360 432 504 576Walk 17 min/ mile 240 288 336 184Swimming 360 432 504 576Stretching yoga 240 288 366 384Weight lifting 180 216 252 288Dancing disco 330 396 462 528Gardening 270 324 378 432Sitting/reading/watching TV 68 81 95 108Sleeping 38 45 53 60(Source: “The week” Feb 24, 2004) XTable no.95-Recommended energy intake according to age, height, and weight: Category Age Weight Height Average energy In yrs In kg In cm allowance (kcal) Per kg per day Infants 0.0-0.5 6 60 108 650 0.5-1.0 9 71 98 850 1-3 13 90 102 1300 Children 4-6 20 112 90 1800 7-10 28 132 70 2000 11-14 45 157 55 2500 15-18 66 176 45 3000 Men 19-24 72 177 40 2900 25-50 79 176 37 2900 51+ 77 173 30 2300 11-14 46 157 47 2200 15-18 55 163 40 2200 Women 19-24 58 164 38 2200 25-50 63 163 36 2200 51+ 65 160 30 1900Ef Effect of Udvarthana in Sthoulya
  • AnnexureTable no.96-showing height and weight for women of different ages:Height Weight in kg for different ages in yearsin cms 20 25 30 35 40 45 50148 38.6 41.0 42.6 44.0 45.1 46.3 47.1150 40.3 41.6 43.5 44.8 46.0 47.0 47.7153 41.9 43.5 45.3 46.6 47.9 48.4 49.5155 42.8 44.3 46.2 47.7 48.8 49.5 50.1158 44.9 46.3 48.1 49.5 50.4 51.6 52.1160 46.0 47.3 49.1 50.6 51.5 52.4 53.0163 47.3 48.8 50.8 52.1 52.2 54.1 54.9165 49.1 50.6 52.6 54.1 55.3 56.0 57.3168 50.0 52.1 53.8 55.6 56.8 57.7 59.0Table no.97- showing height and weight for men of different ages:Height Weight in kg for different ages in yearsin cms 20 25 30 35 40 45 50 XI148 42.7 44.2 46.2 47.6 48.8 50.0 50.9150 43.6 44.9 46.9 48.5 49.7 50.8 51.5153 45.4 47.0 49.0 50.4 51.7 52.3 53.5155 46.3 48.1 49.9 51.5 52.7 53.5 54.2158 48.6 50.0 52.0 53.5 54.5 55.7 56.3160 49.7 51.1 53.1 54.7 55.6 56.7 57.4163 51.1 52.7 54.9 56.3 57.6 58.5 59.4165 53.1 54.7 56.9 58.5 59.7 60.6 62.0168 54.0 56.3 58.1 60.1 61.5 62.4 63.7170 56.5 57.9 60.3 62.2 63.7 64.7 65.8173 58.1 60.1 62.2 64.0 65.8 67.0 68.3175 60.1 62.2 64.2 66.0 68.1 69.7 71.0178 61.9 64.0 66.3 68.5 70.6 71.9 72.4180 64.0 66.2 68.5 71.0 73.3 74.4 75.1Ef Effect of Udvarthana in Sthoulya
  • Annexure Table no.98-showing common Indian cereals with their nutritive valueFood Protei Fat CHO Calorie Fiber Ca B1 Niacin n (gm) (gm) s (gm) (mg) (mg) (mg) (gm)Barley 11.5 1.3 69.4 335 3.9 0.03 0.47 4.7Jawar 10.4 1.9 72.4 349 1.6 0.03 0.37 1.8Maize 4.3 0.05 15.1 82 - 0.01 0.11 0.6Ragi 7.1 1.3 72.7 331 3.6 0.33 0.42 1.1Rice 13.5 16.2 48.4 393 4.3 0.07 2.70 28.0Wheat floor 11.8 1.5 71.2 348 1.2 0.05 0.35 5.0Bengal 20.8 5.6 59.8 372 1.2 0.06 0.48 2.4gramBlack gram 24.6 1.4 60.3 350 0.9 0.20 0.42 2.0Cow gram 24.0 0.7 55.7 327 3.8 0.07 0.50 1.3Green gram 24.0 1.3 56.6 334 4.1 0.14 0.47 2.0Horse gram 22.0 0.5 57.3 322 5.3 0.28 0.42 1.5Peas 19.7 1.1 56.6 315 4.3 0.07 0.45 2.3Red gram 22.3 1.7 55.7 327 1.5 0.14 0.45 2.4 XII Table no.99-showing common Indian vegetables with their nutritive value:Food Pro Fat CH Calor Fiber Ca B1 Vit-c Niacin gm gm O ies gm mg mg mcg (mg) gmCabbage 1.8 1.0 6.3 33 1.0 0.08 0.06 124 0.4Coriander 3.3 0.6 5.3 40 1.2 0.14 0.05 135 0.8curryleaves 6.1 1.0 16.0 97 6.4 0.81 0.08 004 2.3Spinach 1.9 0.9 3.4 30 0.6 0.06 0.05 28 0.5Beet root 1.7 0.1 13.6 62 0.8 0.20 0.04 10 0.4Carrot 0.9 0.2 10.7 47 1.1 0.08 0.04 03 0.4Onion 1.8 0.1 13.2 61 0.6 0.04 0.08 02 0.5Potato 1.6 0.1 22.9 99 0.4 0.01 0.10 17 1.2Radish 0.6 0.3 7.4 35 0.6 0.05 0.06 17 0.4Cucumber 0.4 0.1 2.8 14 0.4 0.01 0.03 07 0.2 Ef Effect of Udvarthana in Sthoulya
  • Annexure Table no.100- showing miscellaneous Indian foodstuff with their nutritive value:Food Pro Fat CHO Calo Fiber Ca B1 Vit-c Niacin gm gm gm ries gm mg mg mcg (mg)Almond 20.8 58.9 10.5 655 1.7 0.23 0.24 00 4.4Cashew nut 21.2 46.9 22.3 596 1.3 0.05 0.63 00 1.2Groundnut 26.7 40.1 20.3 549 3.1 0.05 0.90 00 14.1musteredseed 22.0 39.7 23.8 541 1.8 0.49 0.65 00 4.0Sesameseed 18.3 43.3 25.2 564 2.9 1.45 1.01 00 4.4Lemon 1.0 0.9 11.1 57 1.7 0.07 0.02 39 0.1Orange 0.9 6.3 10.6 49 - - 0.12 68 0.3Papaya 0.5 0.1 9.5 40 - - 0.04 57 0.2Fish 17.6 3.1 1.0 86 - - - - -Egg 13.3 13.3 - - - - - 02 -Mutton 18.5 13.3 - - - - - - -Pork 18.7 4.4 - - - - - 02 -Milk 4.3 8.8 5.1 - - - - 05 -Curds 2.9 2.9 3.3 - - - - 01 - Table no.101-Reducing and weight maintenance diet of high cost (gm/day) XIII Reducing diet Weight maintenance diet Diet I Diet II Diet III Diet IV Foodstuff (1100 (1300 (1500 (1800 Veg N.veg Veg N.veg Veg Non.veg Veg Non.vegCereals 80 80 100 100 100 100 150 150Legumes 50 50 60 60 60 60 80 80Milk 1000 500 1000 500 1000 500 1000 500Eggs 1 - 1 - 1 - 1Meat/ fish 100 - 100 - 150 - 200Green leafy. 200 200 200 200 200 200 200 200Other veg 200 200 200 200 200 200 200 200Roots/tubers 50 50 50 50 50 50 50 50Fruits 50 50 50 50 50 50 50 30Fats / oils 15 15 20 20 30 30 30 30 Ef Effect of Udvarthana in Sthoulya
  • Annexure Table no102-Reducing and weight maintenance diet of medium cost (gm/day) Reducing diet Weight maintenance diet Diet I Diet II Diet III Diet IV Foodstuff Veg N.veg Veg N.veg Veg N.veg Veg N.vegCereals 100 100 150 150 150 150 220 220Legumes 100 100 100 100 100 100 100 100Milk 500 300 500 300 500 300 500 300Nuts 30 - 30 - 60 30 60 30Meat, fish - 50 - 50 - 50 - 50Green leafy 200 200 200 200 200 200 200 200Other veg. 200 200 200 200 200 200 200 200Roots/tubers 50 50 50 50 50 50 50 50Fruits 50 50 50 50 50 50 50 50Fats / oils 15 15 15 15 15 15 15 15 Table no 103-Reducing and weight maintenance diet of low cost (gm/day) XIV Reducing diet Weight maintenance diet Diet I Diet II Diet III Diet IV Foodstuff (1100 (1300 (1500 (1800 Veg N.veg Veg N.veg Veg N.veg Veg N.veg Cereals 120 120 170 170 170 170 240 240 Legumes 100 100 100 100 100 100 100 100 Milk 300 200 300 200 300 200 300 200 Nuts 30 - 30 - 60 30 60 30 Meat, fish - 30 - 30 - 30 - 30 Green leafy 200 200 200 200 200 200 200 200 Other veg. 200 200 200 200 200 200 200 200 Roots/tubers 50 50 50 50 50 50 50 50 Fruits 50 50 50 50 50 50 50 50 Fats / oils 15 15 15 15 15 15 15 15 Ef Effect of Udvarthana in Sthoulya